Euthanasia Consent Form | Rockwall Urgent Vet

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.*

Yes
No

Rabies 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*

Name

This field is for validation purposes and should be left unchanged.