Contact Us
Please complete the entire form to request an appointment. You may review our costs on our "Services and Pricing" page. We accept cash, checks and credit/debit cards.
Your name:
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First Name
Last Name
Email:
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example@example.com
Phone Number (must be able to receive text messages):
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Please enter a valid phone number.
Format: (000) 000-0000.
Address where you would like us to see your pet:
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
What is your pet's name?
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Your pet's species:
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Dog
Cat
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Male
Female
Your pet's age (in approximate years):
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Your pet's breed:
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If known; if unknown, please type "Mixed"
Your pet's weight (lbs):
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*Please note: we need this to be as accurate as possible to insure the correct drug doses are administered to your angel*
Your pet's veterinarian:
If your pet does not currently see a vet, please type "none"
Please use this section to give us any information about your pet that you feel we should know. You may also let us know about any special requests or questions you may have for your pet's appointment.
Please choose preferred aftercare (please note that regardless of aftercare choice, every peaceful passing receives a pawprint/frame combination, and lock of fur in a keepsake frame):
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Private Cremation - Premium (your angel is cremated separately and returned to you in a decorative urn)
Private Cremation - Basic (your angel is cremated separately and returned to you in a temporary plastic urn)
Communal Cremation (your angel's ashes are not returned, but are interred in a butterfly garden along with other pets)
Private Burial/other (you are taking care of your angel's aftercare)
Not sure at this time
If you chose Private Cremation - Premium, please enter your pet's name EXACTLY as you wish for it be engraved on the decorative urn:
Is your pet in need of an urgent (same day) appointment?
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Please Select
Yes
No
Requested Date and Time (Please note that this is NOT an actual appointment. This is when you would like to ideally schedule your appointment. We serve a large area and travel times between appointments may impact our ability to accept an appointment request. We will confirm your actual appointment time when we reach out to you):
I agree to the following (please read and check all):
NO aggressive or reactive pets over 20 lbs. This includes any of the following behaviors: known biter; growling; evasive/extremely fearful; unable to be approached/held/restrained. We reserve the right to cancel or reschedule your appointment if Dr. Aubrey determines it is not safe to continue. A cancellation/rescheduling fee of $150 may be assessed if this occurs. Please be sure to tell us about any behavioral issues we may encounter.
If your pet is over 20 lbs, someone must be available to assist Dr. Aubrey with lifting if needed.
Pets over 100 lbs require special lifting assistance from our crematory partner, with an additional large pet handling fee (please see our Services and Prices page). ***If Dr. Aubrey arrives and there is no lifting assistance for heavy pets, the appointment will be rescheduled at her discretion, and a rescheduling fee of $150 may be assessed if this occurs.***
*You must disclose if your pet has bitten anyone within the last 10 days*
Signature
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