Name* First Last Email* Phone*Pet Name*I hereby certify that I am the owner of this pet. I request humane euthanasia of the above animal and release the staff of Rockwall Urgent Vet from all liability associated with performing the procedure.*YesNoRabies testing is mandatory by the state of Texas if a bite is reported. Please choose one of the following statements:*To the best of my knowledge, this animal has NOT bitten any person in the previous 10 days and has not been exposed to rabies.A bite HAS occurred in the previous 10 days. I understand that additional fees will apply for mandatory state testing and the department of health will be notified.I request the following after-care*Private cremation with return of ashes ($205)Communal cremation with NO return of ashes ($90)Home burial (complimentary burial bag provided for transport)Please Select Memorial Options Below* Paw Impression (Complimentary) Hair Lock (Complimentary) None Signature*NameThis field is for validation purposes and should be left unchanged.