Online Forms

Euthanasia Consent Form

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Online Forms

Euthanasia Consent Form

Please note: After completing your Euthanasia Consent Form, please call us at 305-676-7049 to book your appointment. Submitting this form does not automatically book an appointment with us.

Euthanasia Consent Form

Your Name(Required)

If not applicable, please enter "N/A"

Phone(Required)

If not applicable, please enter "N/A"

Email(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

If not applicable, please enter "N/A" into all fields

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

Owner is responsible for payment of valet fees.

Who do I have to thank for this referral?

If not applicable, please enter "N/A"

Pet's Name(Required)

If not applicable, please enter "N/A"

Rabies tag number or registration number (if available)

If not applicable, please enter "N/A"

Species(Required)

If not applicable, please enter "N/A"

Breed(Required)

If not applicable, please enter "N/A"

Color(Required)

If not applicable, please enter "N/A"

Age/Date of Birth(Required)

If not applicable, please enter "N/A"

Weight(Required)

If not applicable, please enter "N/A"

Sex(Required)

Male

Male (neutered)

Female

Female (spayed)

N/A

Are any young children in the home(Required)

Yes

N/A

Do you have a regular veterinarian?(Required)

Yes

Who is your regular veterinarian.(Required)

If not applicable, please enter "N/A"

Reason for euthanasia/diagnosis(Required)

DVM(Regular Veterinarian) Email

If not applicable, please enter "N/A"

DVM(Regular Veterinarian) Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

If not applicable, please enter "N/A" into all fields

DVM(Regular Veterinarian) Phone Number

If not applicable, please enter "N/A"

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 hereby grant permission for a postmortem study of my pet, if deemed necessary by the veterinarian. I request that my pet’s remains be cared for as follows:(Required)

Private cremation with the ashes returned.

Communal cremation without return of the ashes.

I will keep my pets remains for a home burial or other accommodations (body bag included).

N/A

Please select an urn option:(Required)

Click here to view our urn options. If not applicable, please enter "N/A"

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

If not applicable, please enter "N/A"

Delivery Options(Required)

Remains can be UPS shipped for an additional $25-$30 or can be picked up at the office in Coral Gables free of charge. Email is required for home shipment of remains. Please note: UPS shipment will require a signature upon delivery. If not applicable, please enter "N/A"

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. Click here to create a memorial for your pet.

Signature(Required)

Date(Required)

MM slash DD slash YYYY

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Servicing Miami and surrounding areas

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Service Area

Servicing Miami, FL and surrounding areas

•additional fees may apply for after hours or significant distance

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Hours

Opened 24 hours

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Contact

P: 305-676-7049
E: contact@mypetsatpeace.com