New Customer Registration Form

Please be aware that the email these forms are submitted to is only consistently checked between 9am and 6pm, Thursday through Monday, and there may be a delay of several hours in response time.

IF YOU ARE INQUIRING ABOUT A SERVICE NOT LISTED ON OUR WEBSITE, there will not be a response, as we are limited to those services only.
Customer Details:
Full Name*

First NameLast Name
Pet name*
Pet breed*
If unknown, can say mixed, feline, etc
Pet weight*
Pet age*
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 cremationIn home euthanasia without cremation (you are handling aftercare)Comfort room euthanasia with cremationComfort room euthanasia without cremation (you are handling aftercare)In home assessment for hospice & palliative careQuality of Life Consult
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 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:

Please be aware that the email these forms are submitted to is only consistently checked between 9am and 6pm, Thursday through Monday, and there may be a delay of several hours in response time.