Your Name(Required)

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Phone(Required)

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Email(Required)

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Address(Required)

Street Address Address Line 2 City State ZIP Code

Special Instructions (gate code, specific parking required, etc.)

Owner is responsible for payment of valet fees. If not applicable, please enter "N/A"

Who do I have to thank for this referral?

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Pet's Name(Required)

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Rabies tag number or registration number (if available)

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Species(Required)

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Breed(Required)

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Color(Required)

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Age/Date of Birth(Required)

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Weight(Required)

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Sex(Required)

Are any young children in the home(Required)

Yes

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Do you have a regular veterinarian?(Required)

Yes

Who is your regular veterinarian.(Required)

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Reason for euthanasia/diagnosis(Required)

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DVM(Regular Veterinarian) Email

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DVM(Regular Veterinarian) Address

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DVM(Regular Veterinarian) Phone Number

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Is your pet registered with Miami-Dade County?(Required)

Yes

N/A

I am the owner (or authorized agent of the owner) of the animal described above. I hereby order and give Pets at Peace and its personnel complete authority to euthanize my pet in whatever humane manner they deem appropriate, and to dispose of its remains as specified below and in accordance with hospital policy. I hereby forever release Pets at Peace and its personnel from any liability that may arise from euthanizing or disposing of my pet. To the best of my knowledge, my pet has not bitten any person or animal during the past fifteen (15) days, nor has my pet ever been exposed to rabies. I request that my pet’s remains be cared for as follows:(Required)

Traditional Urns

Click here to view our urn options.

Please select an urn option:(Required)

Pets name as you would like it to appear on Urn name plate (if applicable)

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Delivery Options(Required)

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I have carefully read and fully understand this consent form. The fees associated with these services have been explained to me, and I agree to pay such fees in full at the time of service.(Required)

I have read and understand this consent form.

As part of our commitment to our loving and dedicated pet owners, we would like to give you the opportunity to create a lasting tribute to your pet on our website.

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Online Forms

Euthanasia Consent Form

Online Forms