New Customer Registration Form

Please be aware that the emails these forms are submitted to are only consistently checked between during our regular hours (please see Google) and there may be a delay of several hours in response time. We are closed Tuesday afternoons & Wednesdays to allow for weekend services. ***OUR VET WILL BE HAVING AN INTENSIVE MEDICAL TREATMENT ON 1/22, at this time (1/13/25) we are not scheduling past 1/21.***

This form is for EUTHANASIA services only. If you submit it for other services, you may not receive a response. ***NOT LICENSED IN GEORGIA OR NORTH CAROLINA, so we cannot provide home euthanasia services in these states.***
Customer Details:
Full Name*

First NameLast Name
Pet name*
Pet breed/species*
If unknown, can say canine mixed, feline, etc
Pet weight*
Pet age*
Pet gender, and spayed or neutered?*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
E-mail
Service(s) you are inquiring about and would like a cost estimate for:*

In home euthanasia with communal cremationIn home euthanasia with individual cremationIn home euthanasia without cremation (you are handling aftercare)Comfort room euthanasia with communal cremationComfort room euthanasia with individual cremationComfort room euthanasia without cremation (you are handling aftercare)
Please briefly describe your concerns about your pet's health*
Your pet's primary veterinarian (if applicable)
How did you hear about us?*
Preferred contact method*

Phone callEmailText message
If your pet may be reactive, PLEASE let us know ahead of time so that we can plan properly to minimize their stress (every step of our care is designed to minimize stress for your pet, but for reactive pets some initial steps may need to be modified). If we are unable to safely and gently administer the initial medication injection, you will be charged the full cost of the euthanasia and any time/distance fees. Please initial below to indicate you understand. Thank you.*
IF WANTING TO SCHEDULE, PLEASE LIST 3 DATES AND TIMES BELOW THAT YOU WOULD PREFER (please do not use this form for urgent requests - call 864-274-5756 or text 864-214-5774).
Date

MonthDayYearHourMinutesAM/PM Option
Date

MonthDayYearHourMinutesAM/PM Option
Date

MonthDayYearHourMinutesAM/PM Option
Should be Empty:

Customer Details:

IF WANTING TO SCHEDULE, PLEASE LIST 3 DATES AND TIMES BELOW THAT YOU WOULD PREFER (please do not use this form for urgent requests - call 864-274-5756 or text 864-214-5774).