Veterinary Clinic
Patient intake, surgery and euthanasia consents, treatment estimates, discharge instructions, and boarding agreements for small-animal veterinary practices
Get started with PocperPatient intake, surgery and euthanasia consents, treatment estimates, discharge instructions, and boarding agreements for small-animal veterinary practices
Get started with PocperWe are so sorry you are facing this decision. Please take your time with this form. If anything feels unclear or overwhelming, our team is here to walk you through each section.
Pet’s name:
Species / breed:
Approximate age:
Current weight:
Owner name:
Best phone number today:
Date of procedure:
Please describe your pet’s condition and the reason for this decision:
Euthanasia is performed in two steps. First, a sedative is given so your pet becomes deeply relaxed and unaware. Then an overdose of anaesthetic is given by IV, which gently stops the heart within a minute or two. You may see small reflex movements, breaths, or a release of the bladder or bowels after passing — these are normal and your pet is not suffering.
I have had the procedure explained to me and understand it is irreversible.
Whatever you choose is okay. Many families find comfort in being present; others prefer to say goodbye beforehand.
I wish to be present throughout the procedure.
I wish to be present only for the sedation, not the final injection.
I prefer to say goodbye beforehand and not be present.
Private (individual) cremation — ashes returned to me in an urn or wooden box
Communal cremation — ashes not returned
Take my pet home for home burial (please check local regulations)
I will arrange pick-up with my own service
We can prepare the following keepsakes at no extra charge unless noted. Please tick anything you would like.
Ink or clay paw print
Clipping of fur
Memorial photo
No keepsakes, thank you
Upload a photo you would like us to include with the keepsake package (optional):
I certify that I am the legal owner of this pet (or an authorised agent) and freely consent to euthanasia and the aftercare option selected above.
To my knowledge, this pet has not bitten any person or animal within the past 10 days.
Anything you would like the team to know about your pet as we say goodbye:
Thank you for giving your pet a lifetime of love. We are honoured to be with you today, and we will take the utmost care of them.
The Euthanasia Consent & Aftercare Preferences template is a ready-to-use form from Pocper's Veterinary Clinic pack. Customize the fields to match your workflow, then share a link so clients can complete it and upload documents in real time.