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Euthanasia Consent Form

Euthanasia price is based on weight: 0-50lbs $350, >50lbs $400

Pet Weight

I certify that I am the caregiver or authorized agent of the caregiver of the patient listed below. As the caregiver or agent, I herby give consent to Wholistic Housecalls LLC to perform euthanasia services, therefore terminating life of the pet listed below. This procedure has been explained to me.

I accept the charges for this service listed above. An emergency request Fee: $50 added for same day bookings. Additional charges and regulations for aftercare were discussed. I release the pet listed below to Wholistic Housecalls for:

Aftercare Options

Due to staffing and logistics I can no longer offer cremation of patients weighing greater than 80lbs.

Option 1: Pets left in care of caregivers after the euthanasia for home burial


Option 2: Private cremation

Each pet cremated individually. Ashes will be returned to your home in an urn: Dark Wood, Light Wood, and Metal Tin options available.

 

Cost based on pet weight:

0-25lbs $130, 26-50lbs $160, 51-80lbs $200

 

Option 3: Communal Cremation

Pets are cremated with other pets and ashes are spread together over green space. Ashes will not be returned to you.

 

Cost based on pet weight:

 0-25lbs $50, 26-50lbs $75, 51-80lbs $100

Do you wish to donate towards The Gray Muzzle Project, a 501(c)3 non profit dog sanctuary with a mission to provide hospice care and forever homes to special needs and senior dogs on the Olympic peninsula? For more information please visit www.thegraymuzzleproject.org

Payment Options

I choose to prepay with a card via square (a secure platform). If this option is chosen an invoice will be prepared and emailed to email the address listed on file.
I choose pay at the visit. Payment options include Cash, Check, or Credit Card (all major Credit Cards are accepted).

To the best of my knowledge, the information I have provided on this form is true. I do certify that my pet has not bitten, seriously scratched, or exposed anyone to rabies within the last 10 days. I understand that my wishes will be immediately carried out upon signing this agreement. Fees for these services have been explained to me and will be collected at time of service.

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Contact Me

wholistichousecalls@gmail.com

Text: (425)243-2278
TTex

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