Pets to Rest - Registration Form
Please know, your information is confidential. For additional information please see our website link at the bottom of this form (petstorest.ca).
Owner Information
Primary owner
*
First Name
Last Name
Main phone
*
Please enter a valid phone number.
Alternate phone
Please enter a valid phone number.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Buzzer code / parking instructions if applicable
Secondary owner / authorized agent (if applicable)
First Name
Last Name
Address (if different from primary owner)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com
Do we have your permission to securely transmit confidential information over email after you submit this form?
*
Yes
Patient / Animal Information
Pet's name
*
Species
*
Please Select
Cat
Dog
Age or date of birth
*
Breed
*
Sex
*
Please Select
Female Spayed
Male Neutered
Female Intact
Male Intact
Approximate weight (lbs)
*
Colour
*
Microchip / tattoo (if applicable)
Regular veterinary clinic
*
Appointment time frame
*
Please Select
Urgent / today / tomorrow
This week
This month
Other
Current health condition(s) and concerns
*
0/300
What is the temperament of your pet with visitors to the home?
*
Please Select
Friendly with everyone
Shy but no history of biting
Fearful and be cautious
Likely to bite or scratch
Has your pet previously needed oral sedation for vet visits? If so, or if you feel it may help create a more comfortable experience, please consult your regular veterinarian (we are unable to prescribe this prior to our appointment).
*
Please Select
No
Yes
Has this pet bitten any person in the last 10 days? (Public Health requires a 10 day Rabies quarantine prior to euthanasia in most cases)
*
Please Select
No
Yes
Aftercare & Memorialization Wishes
Aftercare Wishes
*
Please Select
Private Cremation (ashes are returned to you)
Communal Cremation (ashes are NOT returned)
Other arrangement by you
Would you like a free ink paw print?
Please Select
Yes
No
To be mailed or taken at your home if making your own aftercare arrangements
If you wish to purchase a clay paw print, please specify (see Service and Pricing Guide for pricing and Gateway Pet Memorial for design/colour):
If you choose a Precious or Lasting Paw print, please specify name as you wish it to appear:
How memorialization items and the ashes, if applicable, will be returned to you:
Please Select
To be sent to my regular clinic for me to pick up
I don't have a regular clinic so please deliver to my home (additional shipping fee applies, variable)
For Private Cremation Only
Complimentary urns and alternative choices from Gateway Pet Memorial
Complimentary Urn Option
Please Select
Carved Wood Urn
Cedar Memorial Urn
Decorative Metal Urn - Blue
Decorative Metal Urn - Tan
Scattering Tube
If you chose a wood or metal urn, what name would you like engraved (complimentary)?
I choose an alternative urn option from the Gateway Pet Memorial site:
Please contact Pets to Rest for pricing information
I choose engraving for the selected alternative urn:
Note limitations depending on chosen item
Did We Miss Anything?
Please let us know if you have any questions, concerns or requests that were not already addressed?
Please verify that you are human
*
Submit
London In-Home Pet Euthanasia Website: petstorest.ca
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