Pet Euthanasia Consent Form

Please complete this consent form prior to your pet's euthanasia appointment. This form ensures we have all the necessary information to provide the best care during this difficult time.

Important: Please fill out this form completely and have it ready when the veterinarian arrives. If you have any questions about the form or the process, please call us at (760) 912-0848.

Owner Information

First Name

Last Name

Address

Phone Number

Pet Information

Pet Name

Species

Breed

Color

Age

Weight (lbs)

Aftercare Selection

Euthanasia Only — Starting at $450. You keep your pet's body for home burial or transport. Euthanasia + Communal Cremation — Starting at $550. Ashes will not be returned. Euthanasia + Private Cremation — Starting at $750. Ashes returned in a cedar box.

This cost applies for 20 miles radius from our location in Rancho Cucamonga.

Prices may vary depending upon the distance and weight of the pet. For more information call or text (760) 912-0848.

Consent & Authorization

I, the undersigned, being the owner or authorized agent of the owner of the above-described pet, do hereby give Pet Home Euthanasia Services and Dr. Hany Soliman full authority to perform euthanasia. I understand that euthanasia is an irreversible procedure and that it will result in the death of my pet. I release Pet Home Euthanasia Services from any and all liability related to the euthanasia and aftercare of my pet.

Signature

📝 Digital signature will be collected at the time of appointment