Consent form

What matters most to your animal companion on the day of their passing?
See Dr. Curtis explain in a video HERE

in home euthanasia preparation & planning video (shorts) series

consent form

* Indicates required field

Name *

First

Last

Pet's Name *

Email *

Phone Number *

1) My pet has not bitten anyone in the past 14 days and has not been exposed to rabies *

2) Cosmic Light has my permission to euthanize my pet to avoid unnecessary pain and suffering *

3) I have been present for or have witnessed a euthanasia of a pet before. *

4) Cosmic Light will provide me/my family with the ability to be with my pet throughout the entire procedure. I understand that my pet will not be taken out of my sight at any point of the process for catheter placement or restraint, and I will be able to witness each step that is necessary for my pet's euthanasia. I understand any risks of being present for my pet's euthanasia experience. *

5) Cosmic Light will provide medication intended for sedation, anesthesia and euthanasia of my pet. I have been made aware of the general steps of this procedure and do not hold Cosmic Light responsible for any unforeseen adverse reaction to medication or administration of medication given at the time of the procedure. *

6) Cosmic Light will make every attempt to deliver a peaceful, painless euthanasia experience for my pet. I do not hold Cosmic Light responsible for any undiagnosed medical conditions that my pet may have at the time of the procedure that could effect the experience for me or my pet. *

Preferred method of payment *

Client Signature *

Today's date *

Submit

Additional fees:
Extended travel, urgent/same day appointments, arrangements made outside business hours, aggressive pets