Owner's Name *

First Name

Last Name

Phone *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Sex *

Male

Female

Would you like ashes returned? *

Please be advised it can take 4 weeks for ashes to be returned to our facility. We will reach out as soon as ashes arrive back at our facility to let you know when they can be picked up. Please ask your technician if you have any additional questions.

Yes

No

Additional Services

Below are the additional services that can be added to your pet's cremation services. Please feel free to ask the front desk or one of your technicians if you have any additional questions.

Additional Clay Paw ($27)

Additional Urn ($35)

Fur Clipping ($5)

Ink Print ($17)

Engraving or Nameplate for Urn ($15)

Cremation Release and Consent Form *

I do hereby certify that I am the owner (or duly authorized for the owner) of the animal described above. I do hereby give the doctors of High Country Veterinary Hospital, their staff, and representatives full and complete authority to handle the aftercare of said animal in accordance with hospital policy, unless otherwise instructed. I do hereby release the doctors, staff, and/or representatives of High Country Veterinary Hospital from any and all liability for aftercare of said animal.

I agree to the above statement and authorize the aftercare of my pet