GVH Cremation Authorization

Georgetown Veterinary Hospital

Client Information

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Pet Information

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I, the undersigned, do hereby certify that I am the owner, or duly authorized agent for the owner, of the animal described above and that I do hereby give Georgetown Veterinary Hospital, its veterinarians, agents and/or representatives full and complete authority to cremate said animal above.

I do also certify that the said animal has not bitten any person or animal during the last fifteen (15) days and to the best of my knowledge has not been exposed to Rabies.

I the owner/agent accept full financial responsibility for all charges incurred for the cremation choice made below.  I understand that payment is due in full unless prior arrangements have been made with GVH management.

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Georgetown Veterinary Hospital uses “Argos Cremation Service”. Your pet will be picked up from our office on Friday and typically returned the following Friday at which time a staff member will call you to inform you the ashes are ready for pick up.

 

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GVH Cremation Authorization

GVH Cremation Authorization

Georgetown Veterinary Hospital

Client Information

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Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Pet Information

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Species {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Breed {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Sex {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Age {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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I, the undersigned, do hereby certify that I am the owner, or duly authorized agent for the owner, of the animal described above and that I do hereby give Georgetown Veterinary Hospital, its veterinarians, agents and/or representatives full and complete authority to cremate said animal above.

I do also certify that the said animal has not bitten any person or animal during the last fifteen (15) days and to the best of my knowledge has not been exposed to Rabies.

I the owner/agent accept full financial responsibility for all charges incurred for the cremation choice made below.  I understand that payment is due in full unless prior arrangements have been made with GVH management.

Burial/Cremation Choices {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Individual Cremation Options {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Remembrance Keepsake Options {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Signature {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Date {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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