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 to be present with your pet?

Yes

No

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

I would like to take my pet home for at home burial

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 your technician if you have any additional questions.

Additional Clay Paw ($27)

Additional Urn ($35)

Fur Clipping ($5)

Ink Print ($27)

Engraving or Nameplate for Urn ($15)

Euthanasia Consent and Release 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 euthanize and 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 euthanizing and aftercare of said animal.

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