Euthanasia Consent and Visit Information

Thank you so much for filling out this information before your appointment. It also explains the process, but please don't hesitate to get in touch if you have any questions before we see you.

All appointment times have a one-hour arrival window, and I'll text you when I'm on my way so you know when I'll be at your home.

Take good care, Dr. Carrie

Questions marked * are required. Your price updates at the bottom of the screen as you go.

Client information

Name *

Cell phone for texting *

Email *

Our communication takes place primarily by text, so please make sure to enter the phone number you'd like us to text.

If you don't text, what's the best way to reach you?For example, a phone call to a landline, or email. Leave blank if texting is fine.

Address where services will be provided *

County *Filled in automatically when we find your address.

Mailing / shipping address, if different from above

Type of home *

House Apartment or condo buildingA building with shared entrances or hallways Townhouse, duplex or condo with its own outside door Mobile home OtherPlease describe it below

Description of your home *To help the doctor find it easily, for example the color of the house or building. Please also tell us where your house numbers are (for example, on the mailbox, above the garage, or next to the front door).

Parking If you have a driveway, we will most likely plan to back in for ease and discretion. If not, please describe another parking area. The closer we can be to your pet, the easier it is for everyone.

Patient information

Pet's name *

Species *

Dog Cat Special speciesWe can care for rabbits, rats, guinea pigs, chinchillas, ferrets, hamsters and birds. Please let us know if you have another species in need of care.

My pet is *

Female Male

Age (can be approximate) *

Weight in pounds *

Breed *

Color and/or markings *

Medical conditions, reason for end of life visit *

Additional information about your pet or the visitPlease let us know ahead of time if your pet may try to nip or bite, either with new people or with injections, and if so, what steps you can take to prevent a bite. This helps us go forward safely.

Procedure information

When I arrive at your home, I'll take time to meet you and your pet, discuss anything you'd like and answer any questions. We can be wherever you and your pet are most comfortable: inside or outside, in their bed, on the floor, on the couch or in the grass. You may be able to hold your pet in your lap, as long as we can position them with no movement and good access to give medications.

If you choose to be outside in warmer weather, be aware that as the sedative takes effect, pets can't regulate their body temperature as well, and you may see increased panting and fast breathing as they relax.

The procedure first involves an injection of a sedative, which usually takes about 5 to 10 minutes to take full effect. This lets your pet fully relax and take some deeper breaths until they are deeply sedated and won't feel anything. The sedative injection is just like getting a vaccine and can cause a reaction, as any shot can. You may need to hold your pet still for it.

Offering a favorite food or tasty treats is very helpful during the first injection. If your pet isn't eating, talking to them, petting them and scratching their ears can help them focus on you instead of me.

Any reaction to the injection is very temporary and is almost immediately replaced by a calm, euphoric feeling as pain drifts away. I'll usually step away after the first injection to prepare for the next, which also takes about 5 to 10 minutes. When you're ready, I'll give the final injection into a vein. I'll place a tourniquet, clip the fur in that area, and once I have IV access and the injection begins, your pet will peacefully cross over the rainbow bridge. Sometimes this happens before the injection is completely given.

I usually use the hind leg area for injections so you can be up front near your pet's head. You can keep talking to your pet through the procedure; they can hear you. The final injection usually takes about 2 to 5 minutes to give. Afterwards, I'll listen to your pet's heart and let you know that he or she has peacefully passed.

I'll always explain as much as you'd like about what I'm doing and why. If you don't need more information or don't feel like talking, that's absolutely okay too.

More on getting ready: Preparing for your visit

Aftercare

After the procedure, we'll help coordinate aftercare for your pet. If cremation is chosen, the doctor will carefully transport your pet to Trusted Journey Cremation Service in Poynette. With individual cremation, everything is typically ready within 2 weeks.

What would you prefer for aftercare? *

Individual cremationYour pet is cremated individually, and the ashes are returned to you in the urn of your choice. Communal cremationAshes are not returned. Your pet's ashes are scattered in a beautiful country location owned by the cremation service. Home burialIf you have a place for burial or would like to take care of your pet afterwards yourself. Burials must be at least 3 feet deep, with 2 feet of cover.

Prices appear once you've chosen species and weight above.

Included Pawpals paw print * One paw print impression keepsake is included with every service. Dr. Carrie makes it at your appointment, in terracotta. Every family also receives a lock of fur, a memorial stone and seeds to plant. Pawpals paw print keepsake

Yes, please make a terracotta Pawpals print No print, thank you

A few last questions

Primary veterinarian * Please enter the name of your primary vet's practice so we can let them know we provided services. If you don't have one, just say so. If your pet is listed under someone else's name at the clinic, please tell us that too.

Do you have an appointment scheduled? *

Yes, I have an appointment scheduled No, but we're ready and would like to set one upPlease contact me. If you need an appointment in the next 24 to 48 hours, please text us at 608-909-0002. We're not quite ready yetPlease keep this form on file for the future.

How did you hear about our practice?We'd like to reach out in appreciation if a person or clinic referred you. Thank you so much.

Authorization of procedure

I, the undersigned, certify that I am the owner (or duly authorized agent for the owner) of the animal described above, and I give Dr. Carrie Donahue full and complete authority to humanely euthanize this pet.

I release the said doctor, her agents and representatives from any and all liability for euthanizing this pet.

I also certify that this pet has not bitten any person or animal in the last ten (10) days and, to the best of my knowledge, has not been exposed to rabies. If your pet has bitten someone in the last ten days, we are unable to provide euthanasia services until the ten-day period is over, even with permission from animal control.

I have read and agree to the authorization of procedure above. *

Signature *Sign with your finger or mouse.

Printed name *

Date *

Your invoice

Based on your choices. Your final total is confirmed with you before the visit.

How would you like to pay? *

Credit cardWe'll email you an invoice with a secure Stripe payment link. Payment must be made before the visit. Credit card payments include a 3% processing fee. Debit cardWe'll email you an invoice with a secure Stripe payment link. Payment must be made before the visit. No processing fee. ZelleSend to info@fullcirclepet.com. Payment must be made before the visit. CashPlease have cash ready at the start of the visit. CheckPlease make checks out to "Full Circle" and have it ready at the start of the visit.

When to pay: Card and Zelle payments must be made before the visit. If you're paying by cash or check, please have it ready at the start of the visit so you don't need to think about it afterward. Checks should be made out to "Full Circle."

Cancellation policy: There is no charge if your pet passes before the visit, or if you cancel with 4 or more hours of notice. There is a $100 fee if your appointment is canceled with less than 4 hours' notice.

A note on credit card payments: if you pay by credit card and need to cancel for any reason, we'll refund your payment minus the card processing fees, which are non-refundable.

You'll receive a confirmation email with a copy of your invoice after submitting.

Consent Form