Cremation & Aftercare Authorization

Client / owner namePhoneAlternate phoneAddressEmail

Pet nameSpecies / breedWeightkg / lbColor & markingsDate of deathTag / ID #

Communal cremation: my pet is cremated with other pets and the ashes are not returned to mePrivate cremation: my pet is cremated individually and the ashes are returned to meHome burial or other arrangements (where local rules allow):

Urn & keepsakes

Engraving text (print clearly)

Return of remains

I will collect from the clinicDeliver to the address above

Collected by (name)Expected byProvider / crematory

To my knowledge, my pet has NOT bitten a person in the 10 days before death.My pet HAS bitten a person in the 10 days before death. I understand testing may be required before cremation.

I am the owner of the pet described above, or am authorized to act for the owner. I authorize this practice and its aftercare provider to care for my pet’s remains as selected above. I understand that cremation is permanent and that communal cremation means ashes are not returned.

Owner / authorized agent signature

Printed nameDate

Staff member signature

Printed nameDate

Picked up by providerRemains returned to clinicFamily notifiedReleased to family

Cremation & Aftercare Authorization

Owner & pet

Type of cremation

Urn & keepsakes

Return of remains

Bite history

Authorization

Cremation & Aftercare Authorization

Owner & pet

Type of cremation

Urn & keepsakes

Return of remains

Bite history

Authorization