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Client Name*
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Sex*
I, the undersigned, do hereby certify that I am the owner (duly authorized agent for the owner) of the animal described above, that I do hereby give the doctors of Coastal Animal Medical Center, LLC permission to euthanize and dispose of said animal in the manner selected below. I also release the doctors, Coastal Animal Medical Center, LLC , their agents, servants and representatives for any and all liability for so euthanizing and disposing of said animal.
To the best of your knowledge, has this pet bitten any person or animal during the last ten (10) days?*
To the best of your knowledge, has this pet bitten any person or animal during the last ten (10) days?*
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Would you like to have a clay paw print made by our cremation company for $51.72 each?*
Would you like to have a hair clipping for $0?*
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