Euthanasia Consent Form Name*Pets Name*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code I, the undersigned, hereby state that I am the [legal owner/legally authorized representative of the legal owner of the above listed pet and authorized to make all medical decisions regarding this pet. I have declined any further care for the above pet and am hereby authorizing Southlake Crossing Animal Clinic to euthanize the above listed pet. I agree to have Southlake Crossing Animal Clinic choose a euthanasia protocol at their sole and exclusive discretion and have had all my questions and concerns regarding this process answered prior to signing this consent. I attest that the above listed pet has not been exposed to rabies, has not bitten anyone, and has not displayed any signs of unusual attitude or aggression in the last 10 days. It is my desire to provide for my pet decent and humane after-death care, complying with all legal requirements of the area. I authorize Southlake Crossing Animal Clinic to take charge of my pet's remains in accordance with hospital policy, releasing the staff from any and all liability for performing said after-death care.I request that this animal's remains be cared for in the following manner: Private cremation with return of ashes in a Basic Urn (Includes Paw Print w/ Name) Cedar Box with Brass Nameplate Cherry Wood Box with Brass Nameplate Rosewood Box with Brass Nameplate Specialty UrnPrivate cremation with ashes only back in Bio-degradable Urn (Includes Paw Print w/ Name)General Cremation with no return of ashes. My pet’s remains will not be returned to me.Private Burial with Headstone.General Burial with no identifying markerHome burial. I wish to take my pet’s body home.*If Private Creamation with ashes only - Request a Pet Bead $85.00 ____ (desired color) ______________Signature of Owner (Initials)*Date* PhoneThis field is for validation purposes and should be left unchanged.