Roncesvalles Animal Hospital

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Compassionate Care Consent

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"*" indicates required fields

Name of Pet Owner*
I declare I am the owner on account file for this pet and am responsible for all decisions regarding procedures and payments*
Email*
MM slash DD slash YYYY
Time of your appointment*
:

I wish to have my pets ashes returned*
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
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).
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).

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*
I Consent to the above procedure of Euthanasia*

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