DOA form Deceased on arrival I, the undersigned, do hereby certify that I am the owner (duly authorized agent for the owner) of the animal described above.Pet's Name:*Owner's Full Name: First and Last*(If you will be getting ashes in return please fill out the LAST name you would like on the pet's Urn)Phone Number:Phone Number that will be used to contact you when ashes are return if requested.Please read carefully and check mark all that apply:* I, the undersigned, do hereby certify that I am the owner (duly authorized agent for the owner) of the animal described above. I do hereby give Northeast Veterinary Clinic, complete authority to perform the requested services on my deceased animal in whatever manner I have requested. I would like to do the following with my pet's remains: Individual Cremation Communal Cremation (Ashes will not be returned) Clay Paw If you are requesting more than 1 Clay Paw please enter quantity below:Each clay paw at an additional charge.Electronic Signature: By entering my FULL NAME*I certify that this form has been reviewed by me. I have read it and understood all aspects of this form. I understand and agree to its contents.Today's Date:*
