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Humane Euthanasia Consent Form

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Humane Euthanasia Consent Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pet(s) before your visit.

Humane Euthanasia Consent Form Copy

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Authorization for Humane Euthanasia


As owner or duly authorized agent of the owner of the animal described herein, I hereby authorize the veterinarian to euthanize said animal for humane reasons. I further authorize the attending veterinarian to dispose of the remains as chosen below. To the best of my knowledge and belief, this animal has not bitten any person during the fifteen (15) days prior to todays date.

Gem Veterinary Clinic offers the following choices for the remains of your beloved pet. Please indicate your selection below:

Your pet can be buried in a special place you choose.
Your pet’s ashes are scattered in a peaceful mountain location.
(0-30#) $95    (31-60#) $110     (61-90#) $145     (91#+) $170
Your pet’s ashes are returned to you in a handcrafted wood urn.
(0-30#) $130     (31-60#) $150     (61-90#) $195     (91#+) $220

These additional services are available:

A beautiful painting created with your pet’s paw prints by our staff

Please note all ashes not picked up within 12 months will be spread in our beautiful Passing Garden.