Appointment Consent Form in San Diego, Riverside, & Orange County

Appointment Consent Form

Name(Required)

First Last

Appointment Date(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email(Required)

Phone(Required)

Pet's Name(Required)

Pet's Age(Required)

Pet's Weight(Required)

Pet's Sex(Required)

Male

Female

Species(Required)

Breed(Required)

Color(Required)

Primary Vet Clinic(Required)

How did you hear about us?(Required)

Aftercare Arrangement Options(Required)

None, I will arrange aftercare

Individual Cremation (ashes in an urn)

Communal Cremation (ashes spread at sea)

Consent(Required)

I certify I am the legal owner or authorized agent for the owner of the pet described above and give Paws into Grace and any authorized agents, staff or representatives full and complete authority to euthanize and/or provide aftercare for my pet. I forever release and hold harmless Paws into Grace and any authorized agents, staff or representatives from any and all liability for euthanasia and aftercare. If I do not choose aftercare with Paws into Grace, I will handle and take full responsibility for all the aftercare arrangements myself. I am aware of laws and regulations regarding the burial of my pet and understand caution should be taken when handling a pet euthanized with drugs/chemicals. To the best of my knowledge my pet has not bitten, scratched and/or potentially exposed any person or other animal to rabies in the past 10 days. I understand that if the animal described above has bitten or otherwise potentially exposed any person within the time specified, a rabies test may be performed. I understand that euthanasia is the act of ending the life of an animal in a painless way to prevent unnecessary suffering. To the best of my knowledge the information I have provided is accurate and complete. Fees for these services have been explained to me and I assume full responsibility for all charges applicable to such services. I have carefully read and fully understand this form.

Signature(Required)

Date(Required)

Digital Signature Consent(Required)

I accept terms & conditions. Checking the box acts as my digital signature.

Appointment Consent Form

Appointment Consent Form

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