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Cremation Consent Waiver

Thank you for giving us the opportunity to care for your pet(s)! Please complete the following to the best of your knowledge.

CLIENT INFORMATION

Address:

Phone:

PATIENT INFORMATION:

Cause of death? (Please include a description of signs prior to passing)

CONSENT:

A

CREMATION CONSENT

Please read carefully and select one:

1. Private Cremation

A

2. Group Cremation

A

3. Take Home

A
Please select one:
Please select an urn style if you have chosen private cremation.

Rabies Consent

Has your pet bitten anyone within the last 10 days?

A
B
If YES, please read the following:
The patient has bitten someone within the last 10 days...

Signature of Owner/Responsible agent

Signature

Date:

PAW PRINT

Would you like a paw print free of charge?
A
B
Additional Memorial Paw Prints are available for a fee of $12.61.