DOA form in El Paso, TX | Montana Animal Clinic

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 Montana Animal 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)
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:*
MM slash DD slash YYYY