End-of-Life Form

Save time and complete your end-of-life form online from any device at any time before your visit.

End-of-Life Form

If you would prefer to download and complete our end-of-life form and bring it with you to your appointment, please click the button below.

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Owner Information

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Email *

Patient Information

Pet's Name *

Breed *

Sex *

Age *

Color *

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 Foxboro Animal Hospital, or agents and representatives thereof, full and complete authority to euthanize said animal in whatever manner deemed appropriate by the presiding veterinarian. *

I have read and understand the above statement.

I do hereby forever release Foxboro Animal Hospital, its agents and representatives, including said veterinarian, from any and all liability for euthanizing the animal referenced above. *

I have read and understand the above statement.

I certify that the said animal has not bitten any person or animal during the last ten (10) days and to the best of my knowledge has not been exposed to rabies. *

I have read and understand the above statement.

Regarding my animal’s remains, please choose ONE of the following options: *

Private Cremation (ashes returned to me at additional cost)
Communal (Group) Cremation
I will take my animal with me today and make my own arrangements
Please hold my animal here pending my later decision. (*Please note that due to limitations of storage space, pets will be held for one week. All attempts to contact you will be made at that time before releasing the animal for group cremation. You will then be billed our standard group cremation fee.)

Signature of Owner or Agent *

Clear Signature

Date *

Website

End-of-Life Form

End-of-Life Form

Owner Information

Patient Information

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