APPT/INFO REQUEST Form

Please be aware that the email these forms are submitted to is only consistently checked between during our regular hours (posted on our website, the best place to monitor our availability). Requests and inquiries submitted afterhours may not be returned until we are open again. Appointment requests are not a guarantee we will be able to schedule, but we will do our best and we will get back to you as soon as we are able to. This form is for EUTHANASIA +/- CREMATION services only. If you submit it for other services, you will not receive a response as we do not offer any other services.

***NOT LICENSED IN GEORGIA OR NORTH CAROLINA, so we cannot provide home 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*
Male or Female? 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. Please note the only aftercare we offer is cremation - we offer aquamation (water-based cremation) - so if you need us to take your pet with us after euthanasia, but do not want ashes back, select the communal cremation option:*

In home euthanasia with communal cremation (no ashes returned)In home euthanasia with individual cremationIn home euthanasia without cremation serviceComfort room euthanasia with communal cremation (no ashes returned)Comfort room euthanasia with individual cremationComfort room euthanasia without cremation service
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 callText messageEmail (not recommended if wanting to schedule, as this is our slowest contact method)
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.*
I would like:*

Information on pricingTo request an appointment
Preferred dates (if wanting to schedule an appointment):
Date

MonthDayYear
Date

MonthDayYear
Date

MonthDayYear
Should be Empty:

Customer Details:

Preferred dates (if wanting to schedule an appointment):