Red Fern Pets Appointment Form
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
Pet’s name
Species
Dog
Cat
Other
Age of pet
Breed
Pet’s weight
Last known or best guess - please try and be accurate within 5-10 pounds
Sex
Neutered male
Spayed female
Male
Female
Are you the legal owner
Yes
No- I am assisting the owner
Regular veterinarian
A notification of your pet’s passing will be sent
What is going on with your pet?
Does your pet have a history of seizures?
yes
no
Current medications
When are you looking to schedule?
As soon as possible
In the coming days
In the coming weeks
Already scheduled
Have you decided on your pet’s aftercare?
Cremation without ashes returned (additional $30-$100)
Private cremation with your pet’s ashes returned (additional $200-270)
I have plans elsewhere (cemetery/crematory of your chosing)
Home burial (see burial info sheet below)
Urn Preference: For Private Cremation Only (See Image below- urn selection will not affect cost)
C1 - Simplicity Box
C2 - "Borders" Box
C3 - "Tree of Life" Box
C4 - "Rainbow Bridge" Scattering Tube
C5 - "Paw Print" Tin
C6 - Drawstring Velvet Bag
Engraving for urn/nameplate:
Three lines available: "In loving memory", Name, Dates - if desired.
Has your pet bitten anyone in the past 15 days?
Yes
No
Any concerns about the appointment? Aggressive/protective behavior? Concerns about children at the appointment? Anything at all you would like to discuss or need help with?
How would you like to pay?
Cash/check (payable to Red Fern Pets)
Credit/Debit just prior to appointment (invoice delivered via text)
Credit/debit at the appointment
Submit
Should be Empty: