COVID-19 Update:

Dr. Ravina has been fully vaccinated and boosted for COVID-19. We are comfortable with indoor or outdoor appointments with or without a mask. Dr. Ravina is willing and happy to wear a mask at your request, so please let us know if that is your preference. Please inform the doctor if you or any other member of your family is experiencing any COVID-like symptoms or have had recent exposure to a COVID-positive individual, and we will touch base with you to discuss a plan.

Upcoming Closures:

November 21st through 27th, 2023

We are here for you

Home Euthanasia Consent Form

Name: Peaceful Paws Veterinary Hospice
Address: 4041 Santa Cruz Dr., Santa Cruz, CA, 95073, United States
Telephone: 831-708-9588
Price range: $

Serving the entire Santa Cruz County and beyond.

Appointment

Home Euthanasia Consent Form

Complete the form below and we’ll be in touch with you shortly.

Client's Name *

First

Last

Additional Family Member(s):

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Mailing Address (if different from above)

Address Line 1

Address Line 2

City

State

Zip Code

Patient's Name *

Species *

Dog
Cat
Other

If Other, please specify *

Sex *

Male
Neutered Male
Female
Spayed Female

Breed *

Age *

Weight (estimate is okay) *

Presenting Condition(s) *

Veterinarian(s) who have provided care for my pet within the last three years: *

Body Disposition Request

Please note: If chosen, cremation services will be performed by Animal Memorial Service in Gilroy. For individual cremation, standard urn choices can be found in the attachment on your confirmation email, as well as on the crematory website (see the "Memorial Products" tab on their site). Custom urns and keepsakes can also be purchased directly through Animal Memorial Service for an additional fee. *

I have read and understand

Click here to view Animal Memorial Service's additional urn options.

I choose the following care for my beloved's remains: *

I choose communal cremation at Animal Memorial Services and understand the remains (ashes) will not be returned to me.
I choose individual cremation at Animal Memorial Services and remains will be returned to me (see below for options).
I will retain my pet for home burial. By choosing this option I understand I am responsible for researching and abiding by all local, state and federal laws regarding the burial of a pet's body.
I will make my own arrangements for cremation
Other

If Other, please specify *

Urn Selection (If choosing individual cremation, please make a selection) *

Click here to view the standard urn options.

Return of remains: *

I would like cremains to be mailed directly to me.
I would like to pick up cremains directly from Animal Memorial Service.
Other (approvial required, discuss with Dr. Ravina).
N/A (communal cremation or owner to handle aftercare)

I would like clay paw print keepsake (made by Dr. Ravina, included) *

Additional Info/Requests

Additional requests or anything else you would like Dr. Ravina to be aware of:

I hereby certify that I am the owner, or authorized agent of the owner, for the above named animal, and am of legal age (18+). In being the owner/agent, I do hereby give Peaceful Paws Veterinary Hospice full and complete authority to perform euthanasia services. Arrangements for aftercare will be based on the wishes of the owner/agent and are documented above. I do also certify that the above-named animal has not bitten, seriously scratched, or exposed anyone to Rabies within the past fifteen (15) days. I understand my wishes will be carried out after signing this agreement, and on the date and time scheduled with Peaceful Paws Veterinary Hospice. Fees for these services have been explained to me, and will be collected at, or prior to, the time of service. To the best of my knowledge, the information I have provided on this form is true. In the matter of this euthanasia, I agree to indemnify Dr. Gabrielle Ravina, DBA Peaceful Paws Veterinary Hospice, from any loss or liability which they may incur as a result of any inaccuracy whether intended or otherwise in this, my solemn declaration. *

I certify

Owner/Agent Signature *

Date *

Comment

Ready for a visit?

Request an Appointment today.

Get in touch! Call us at 831-708-9588 or complete the form, and a member of our team will be in touch with you shortly.

We’re here to help.

We look forward to getting to know you better and answering any questions you may have. Please use the information below to contact us, and we will be in touch as quickly as possible.

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Mailing Address

4041 Soquel Dr., Suite A206
Soquel, CA 95073

Service Area

Get in Touch

831-708-9588
info@peacefulpawsvet.net

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Our Hours

Phone Hours

Mon – Fri: 8am – 6pm
Sat: 8am – 1pm

Appointment Hours

Mon – Fri: 9am – 5pm
Sat: by appointment (availability varies).

Name *

First

Last

Email *

Phone

Pet's Name *

Species *

Pet's Weight *

City *

How can we help you? *

Website

Locations Served

Our regular service area is Santa Cruz County, within 20 miles and 35 minutes drive time and includes the following areas: Aptos, Ben Lomond, Bonny Doon, Boulder Creek, Brookdale, Capitola, Corralitos, Davenport, Day Valley, Felton, Freedom, Happy Valley, Interlaken, La Selva Beach, Santa Cruz, Scotts Valley, Santa Cruz, Watsonville.

The following locations are outside of our normal service area but may be accommodated if time allows, on a case by case basis, and with an additional fee: Aromas, Campbell, Castroville, Los Gatos, Monte Sereno, Prunedale, Redwood Estates, Royal Oaks, Saratoga, Summit Area.

If you do not see your city listed but are interested in our services, please contact us to see if we are available to travel to your area (additional travel fee will apply if you are outside our service area).