Euthanasia Consent

Name: Western Skies Animal Rehabilitation
Address: Fort Collins, CO, United States
Telephone: 970-388-1995
Price range: $

Euthanasia Consent and Body Care Instructions

We are so sorry you are facing this sad decision. Please fill in the following consent form prior to our visit. If you have questions, don’t hesitate to give us a call at 970-388-1995.

Owner's Name *

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Mailing Address (if different than above)

Address Line 1

Address Line 2

City

State

Zip Code

Email *

Phone *

Pet's Name *

Sex

Male
Female

Breed

Age

Weight

Color

Regular Vet Clinic

How did you find us? *

I certify that I am the owner or authorized agent of the owner, for the above-named animal. In being the owner/agent for this animal, I do hereby give Western Skies End-of-Life Veterinary Care full and complete authority to perform euthanasia services. Arrangements for aftercare will be based on the wishes of the owner/agent and documented below. I release the above-named animal to Western Skies End-of-Life Veterinary Care for: *

Home Burial - I elect to keep my pet for burial in a lawful manner.
Group Cremation - I do NOT want the ashes returned
Private Body Care - I would like the ashes returned
I will make my own aftercare arrangements

For private cremations, you may pick up your pet's ashes from the crematorim

Please choose between these Private Body Care Options *

Traditional Flame Cremation
Aquamation (Guardian Pet Aquamation located in Loveland)
No preference/Will decide later

Click Here to Learn More about Aquamation

Would you like to receive a PawPals paw print of your pet. (No charge) *

Would you like a digital paw print of your pet’s paw? ($15) *

Click here to learn more about digital paw prints

Would you like a clipping of fur (no charge)? *

Optional Memorial

This section is optional. If you'd like a specific urn, please fill out the questions below.

Please note: This is only if you plan on going through with Lasting Paws or Guardian Pet Aquamation.

Which urn would you like? If no urn is selected, ashes will be returned in either a cedar or bamboo urn.

Cedar Urn
Hand Carved Rosewood Urn
Remembrance Urn
Serenity Urn
Decorative Urn - Blue
Decorative Urn - Tan

If you'd like the urn to have engraving, fill out the text box below

Please note: We can engrave up to 2 lines on your urn

To the best of my knowledge, the information I have provided on this form is true. I do also certify that this animal has not bitten, seriously scratched, or exposed anyone to rabies within the past 10 days. I understand that my wishes will be immediately carried out upon signing this agreement. Fees for these services have been explained to me and will be collected at time of service. *

I have read and understand

Client Signature *

Today's Date *

Phone

Get in touch!

Serving families in Northern Colorado including Fort Collins, Windsor, Severance, Wellington, Greeley, Bellvue, Livermore, and Loveland

Also serving Cheyenne, Wyoming

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Contact Us

Phone:
970-388-1995 (Call or Text)
Email:
drburnett@westernskiesvet.com

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Service Area

CO: Windsor, Severance, Fort Collins, Greeley, Loveland, Wellington
WY: Cheyenne

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Hours

Mon - Fri: 8:00 am - 5:00 pm
Sat: 8:00 am - 2:00 pm
Sun: Closed

Have a question?

Send us a message!

Name *

First

Last

Email *

Phone *

How can we help you? *

Phone