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Compassionate Care Consent
Name of Pet Owner
*
First
Last
I declare I am the owner on account file for this pet and am responsible for all decisions regarding procedures and payments
*
Yes
No
Email
*
Enter Email
Confirm Email
Date of your appointment
*
Date Format: MM slash DD slash YYYY
Time of your appointment
*
:
HH
MM
AM
PM
Name and Phone Number of the person attending the appointment.
*
Pet Name
*
I wish to have my pets ashes returned
*
Yes
No
and acknowledge there is an additional charge for this. If Yes, please also complete the next question for your choice of urns.
Complimentary urn choices
Blue scattering tube
Decorative metal Urn - Blue
Decorative metal Urn - Tan
Cedar Latch Urn
I wish to purchase a different urn
Complimentary urns can be viewed under STANDARD URNS at
https://www.gatewaypetmemorial.com/memorial-products-ontario/
Please indicate the name of the one you would like below.
I would like to receive a memorial ink paw print to remember my pet at an additional charge (we will call you once we've received it back for you to pick up).
Yes
No
I would like to receive a memorial fur clipping to remember my pet at an additional charge (we will call you once we've received it back for you to pick up).
Yes
No
Euthanasia protocol
On arrival, the doctor will review your pet's condition. The doctor has the right to refuse to euthanize your pet if they feel it is not appropriate to do so.
Required
*
We will bring your pet into the clinic upon arrival. Sedation will be given and an IV catheter placed.
We will ask you to settle the account.
We will invite you to spend time with your pet before the doctor enters. After the procedure you are welcome to spend time with your pet.
When you have said your final goodbye, please inform us so we can assist you.
I Consent to the above procedure of Euthanasia
*
I Consent to the above procedure of Euthanasia
*
Δ
Home
Services
Pet Medical Services
Surgical Services
Preventive Services
Nutritional Counseling
Wellness & Vaccination
Anesthesia & Monitoring
Health Screening
Additional Pet Services
About Us
Meet Our Team
Cancellation Policy
Our PetPage App
Our Blog
Pet Health
Pet Health Library
How-To Videos
Pet Health Checker
Pet Food Recalls
News
Blood Donor
Helpful Links
Forms
NEW Client Registration
Make an appointment
Rx Refill & Food Request
Compassionate Care Consent
International Travel
Records Release Consent
Contact Us
Make an Appointment
Emergency
Online Store
facebook
instagram