Sundance Veterinary Consent Form Signature * First Name Last Name Phone Number * Pets Name, Age, & Weight * Gender Male Female I certify that I am the owner or authorized agent of the owner, for the above named animal. In being the owner/agent for this animal, I do hereby give Sundance Veterinary Services, PLLC full and complete authority to perform euthanasia services. Arrangements for aftercare will be based on the wishes of the owner/agent and documented below. * Yes No Body Disposition Request I certify that I am the owner or authorized agent of the owner, for the above named animal. In being the owner/agent for this animal, I do hereby give Sundance Veterinary Services, PLLC full and complete authority to perform euthanasia services. Arrangements for aftercare will be based on the wishes of the owner/agent and documented below. I choose private or communal cremation and would like Sundance Veterinary Services to transport my pet to the crematory of my choice. To the best of my knowledge, the information I have provided on this form is true. I do also certify that this animal has not bitten, seriously scratched, or exposed anyone to rabies within the past 10 days. To the best of my knowledge, the information I have provided on this form is true. I do also certify that this animal has not bitten, seriously scratched, or exposed anyone to rabies within the past 10 days. Name First Name Last Name Date MM DD YYYY Thank you!
