End of Life Consent Form - Bronx Veterinary Center

Pet's Records

Owner Name

First Last

Phone

Address

Street Address Address Line 2 City State ZIP Code

Pet's Name

Euthanasia Consent

Signature

Date

Authorization for disposition of pet’s remains

Pick One

Private Cremation: Your beloved pet is placed in a private crematory chamber with a third party company. The remains are then placed in an urn of your choice and delivered back to the Bronx Veterinary Center for pick up. You will have 6 months to pick up your pet’s ashes.

Communal Cremation: Your beloved pet is cremated in a group setting with other pets. Ashes are not returned but receive a proper burial.

Release remains: The beloved pet’s ashes will be released to the owner for proper disposition. (Local laws apply). I also release the Bronx Veterinary Center of all responsibility for disposing of the remains of my beloved pet.

Signature

Date

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