Coastal Rivers Pet Hospital

#2 - 1993 Riverside Road
Abbotsford, BC V2S4J8

(604)425-1900

www.coastalriverspet.com

I, the undersigned, do hereby certify that I am the owner (or duly authorized agent for the owner) of the animal described above, that I do hereby give the doctors of Coastal Rivers Pet Hospitalmpermission to euthanize said animal. I do also certify that to the best of my knowledge the said animal has not bitten any person or animal during the last ten (10) days and has not been exposed to rabies. I understand the finality of this decision and have had adequate time with which to arrive at this decision.

End of Life form Form

Client ID

Client Name

Address
Street Address
City
,
State / Province
Zip / Postal Code
Phone
Phone TypePhone Number
Patient ID

Name

Species

Breed

Sex

Color

Markings

Birthdate :
I would like to be present during the euthanasia appointment
I do not want to be in the room during the euthanasia
I will take my pet home for home burial
I would prefer regular cremation with the remains not returned to me.
I would prefer private cremation with the remains returned to me in an urn
Select urn colour
white
black
pearl
I have chosen a specialty urn / memory paw print / keepsake jewelry
Please circle all applicable
specialty urn
memory paw print
keepsake jewelry
Name of the specialty urn / keepsake jewelry

On the cremation certificate I would like the names to appear as follows:
Owner's Name
First Name
Last Name
Pet's Name
First Name
Last Name
If there are additional details for specialty memory products, please add them here


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