Consent Form

Informed Consent to Euthanasia

I hereby certify that I am a major person and:

I am the lawful owner of the pet described below OR
I am the duly authorised agent of the lawful owned of the pet described below
I hereby give my consent for my pet to be euthanised
I hereby give my consent for disposal of my pet after being euthanised
I hereby indemnify the veterinarians and staff of Paws at Peace Pty Ltd against any claims of whatsoever nature flowing from or related to the euthanasia of the pet described below.

I understand I am able to choose one of the following aftercare options for my pet:

Paws at Peace to arrange private/individual cremation of my pet whereby their ashes will be returned to me by Paws at Peace in the receptacle of my choice (see available choices here) OR
Paws at Peace to arrange burial/group cremation of my pet through a pet cremation service OR
Burial at home/Owner to organise cremation.

Details Required:

* Indicates required field

Pet's Name *

Breed *

Colour *

Gender *

Age *

Regular Vet *

Preliminary Diagnosis *

Aftercare Options *

Owner or Authorised Agent? *

First Name of Owner *

Family Name of Owner *

Street Address *

Suburb *

Email Address *

Phone Number *

Alternate Phone Number *

Plaque Details *

Urn Details *

Click here to see urn options

Availability for Ashes Returns *

Special Requests *

People Present *

I acknowledge that a quote cannot be provided, and that I have been provided with an estimate for an average procedure, but the final cost may vary substantially and be significantly higher than discussed because of the particular factors that may be encountered as the procedure unfolds. I agree to settle the final bill in full upon request or discharge, whichever is earlier.

I understand that I am responsible for the costs associated with euthanasia and the cost of individual cremation or burial if elected AND that full payment must be made at the time of euthanasia. In the case where payment is not possible at the time of euthanasia, I understand that full payment must be made via direct credit into the following account (BSB: 633-000, Account number: 185 819 042, Name on account: Paws at Peace Pty Ltd) within 24 hours of provision of services. Further, I acknowledge that additional fees and charges may apply if payment is not received within seven days of the date of service.

I understand that I am responsible for ensuring that there are enough people present to help lift my pet into the vehicle if Paws at Peace has been asked to arrange aftercare on my behalf. *

I also understand that if there are not enough able-bodied people present to help lift my pet into the vehicle, I will need to arrange aftercare for my pet independently of Paws at Peace. *

In the event of any grievance or dispute with this veterinary facility or its veterinarians, I undertake to enter into and complete the Veterinary Defence Association (NFP) Ltd (VDA)’s free Alternate Dispute Resolution process, before resorting to any other action or remedy.

I acknowledge that this facility is not party to my arrangement with my pet insurer and that no obligations whatsoever are placed on this facility. This facility will not deal with or provide information to pet insurers. I am solely responsible for payment of veterinary fees to this facility and I hereby absolve this facility from all actions, arising directly or indirectly from my pet insurance arrangement.

I acknowledge that this facility will not provide any opinions, reports, certificates, comments, recordings or copies of clinical notes to any person for any purpose, under any circumstances.
* The information outlined below is indicative of the numbers of people needed to safely lift the animal into the vehicle:

Dogs up to 10kg – no assistance needed
Dogs 10kg to 25kg – one additional person will be needed to assist (excluding the vet)
Dogs 25kg to 45kg – two additional people will be needed to assist (excluding the vet)
Dogs more than 45kg – three additional people will be needed to assist (excluding the vet)

I acknowledge that in the event that I default on payment for this service, I will be liable for any fees or collection costs associated with recovering the debt such, but not limited to, bank dishonour fees, collection agency fee, legal costs.

I agree to the terms and conditions detailed above.

Click the box *

Submit

Informed Consent to Euthanasia

Melbourne and surrounds

0490 843 218

[email protected]

Informed Consent to Euthanasia​​​

Melbourne and surrounds

0490 843 218

[email protected]

Informed Consent to Euthanasia