top of page
Home
Request a Consult
About
FAQ
Testimonials
Services
End of Life Sevices
Contact
Online Pharmacy
Forms
New Consult Request
Recheck Exam
Euthanasia Request
Thermal Imaging Request
More
Use tab to navigate through the menu items.
Euthanasia Request Form
Client Information
First Name
Last Name
Street Address
Street Address Line 2
City
State/Province
Postal / Zip code
Email
Phone
Patient Information
Pet Name
Male/Female
Age/DOB
Breed
Spayed/Neutered
Approximate Weight (lbs)
Who is your primary veterinarian/clinic ?
What is the reason youre saying goodbye to your pet?
What days work best for you?
Tuesday
Wednesday
Thursday
Friday
What times work best for you?
Morning
Afternoon
Evenings
What kind of aftercare would you like for your pet?
Take them home
Individual Cremation (recieve ashes back)
Communal Cremation (do not recieve ashes back)
Would you like a clay paw print and ink prints? (additional $30)
Yes, please
No, thank you
Would you like to be present?
Yes
No
Unsure
Any additional information you would like us to know or any questions?
Submit
Thank you for submitting
bottom of page
