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Veterinary Hospital Pet Cremation Authorization Form
Veterinary Hospital Information
Hospital Name
Hospital Address
Hospital Contact Name
Hospital Email
Hospital Phone Number
Hospital Internal Tracking
Pet Owner & Deceased Pet Information
Pet Owner First Name
Pet Owner Last Name
Pet Name
Type of Pet
Select one...
First choice
Second choice
Third choice
Pet Breed
Date of Death
Pet Weight (lbs)
Pet Gender
Select one...
Female
Second choice
Pet Color
Selection of Services & Keepsakes
Eco-Friendly Water Cremation Selection
Select one...
Communal Cremation: This involves multiple pets being present in the cremation vessel without any form of separation. The cremated remains are not available for return to the owners.
Individual Cremation: Each pet is isolated in their own stainless steel chamber during the water cremation process, and each pet's individual cremated remains are available for return to the owner.
Paw Print Qty
Glass Vial of Hair Qty
Receipt of Pet's Cremains
Select one...
Crematory will deliver to Veterinary Office
Veterinary rep will pick up at Crematory
Customer will pick up at Crematory
Crematory will deliver to Customer $45 (alternating Wednesday evenings 6-9pm)
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