Owner's/Agent's Name *

First

Last

Date

Address

Address Line 1

City

State

Zip Code

Phone *

I consent to receive SMS text messages from Washington Family Vet Clinic. Msg & data rates may apply. Reply STOP to opt-out. *

Yes
No

Additional Phone

Email *

Pet's Name *

Species *

Dog
Cat
Other

If other, please list *

Breed

Color

Age

Weight

Sex *

Male
Female
Neutered Male
Spayed Female

How did you hear about our services?

Please list all veterinarians and pet care professionals who have seen your pet within the last three years:

Which cremation service would you like to use? *

WFVC - West Coast
Angel Hutchings - Forever Friends
Dr. Jessica Smith - Peaceful Journey Home Aquamation

Aftercare Arrangement Options

Please select an arrangement *

I will handle and take full responsibility for all aftercare arrangements myself. I am aware of any applicable laws and regulations regarding the burial of a pet’s body and understand caution should be taken when disposing of animals euthanized with drugs/chemicals.
I wish to have Washington Family Vet Clinic arrange for my pet's aftercare (you must select one of the options seen below):
I wish to have a separate cremation service arrange for my pet's aftercare.

I wish to have Washington Family Vet Clinic arrange for my pet's aftercare (you must select one of the following): *

Communal cremation (no ashes returned)
Private cremation with ashes returned to me

I certify that I am the legal owner/duly authorized agent for the owner of the animal described above and do hereby give Washington Family Vet Clinic and any authorized agents, staff, or representatives full and complete authority to euthanize and handle aftercare of said animal in a humane manner. I hereby forever release and hold harmless Washington Family Vet Clinic and any authorized agents, staff, or representatives from any and all liability for euthanasia and disposal of said animal. *

I have read and understand.

Dogs, cats, and ferrets: To the best of my knowledge, the dog, cat, or ferret described above has not bitten, scratched, or otherwise potentially exposed any person or other animal to rabies in the past ten (10) days. Other Species: To the best of my knowledge, the animal described above has not bitten, scratched, or otherwise potentially exposed any person or other animal to rabies in the past thirty (30) days. I understand that if the animal described above has bitten or otherwise potentially exposed any person within the time specified, a rabies test must be performed. *

I have read and understand.

I understand that euthanasia is the act of ending the life of an animal in a painless way to prevent any unnecessary suffering. To the best of my knowledge, the information I have provided is accurate and complete. I understand that my wishes may be carried out immediately upon my signing this agreement. 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 the foregoing provisions. *

I have read and understand.

Owner/Agent Signature *

Date *

Is the above signature Owner or Agent? *

Owner
Agent

Witness Signature *

Date *

Euthanasia Form

Please complete this form before your visit.

Euthanasia Form

Download our app and connect with us on PetDesk!

Caring for pets in St. George and beyond.

Our Location

Our Hours

Contact Info