Peaceful Paws
Clarion
Pet Parent’s Name -Please list first name of both owners if applicable
*
First Names
Last Name
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Pet’s Name
*
Species
Cat
Dog
Breed
*
Gender
Male
Neutered Male
Female
Spayed Female
Color
*
Age
*
Estimated Weight
*
I’m concerned my pet may be particularly anxious, nervous or aggressive
*
Yes
No
Please briefly indicate your pet’s symptoms or diagnosis, reason that in-home end of life care is requested.
*
Pet’s current veterinarian (if any)
Please notify my current veterinarian of my pet’s passing
Yes
No
Other pet care teams you’d like to have notified-groomer, kennel etc. (please list phone number)
Please use the space below to describe any special concerns/spiritual or religious beliefs/things you’d like me to know about you or your family that could be important to our visit if you’d like:
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Aftercare
Chosen aftercare option:
*
Peaceful Paws will provide transport of my pet to Goble Funeral Home for communal cremation. I WILL NOT receive ashes back.
Peaceful Paws will provide transport of my pet to Goble Funeral Home for private cremation and we, the family, WILL PICK UP the ashes. Special arrangements can be made for personalized urns and memorials directly through Goble Funeral Home at 814-226-7730 if interested.
I will provide for my pet’s aftercare through burial or separate funeral home arrangements.
An Opportunity to Give Back to Veterinary Medicine: Some families choose to allow their pet to give a final gift by contributing to veterinary education. With your permission, your pet may help Dr. Amber Bliss at Clarion Animal Hospital to refine orthopedic and advanced surgical techniques. These surgeries, once perfected, will then be an available to treat painful and life threatening surgical conditions in animals that belong to our local families. Your pet will be treated with dignity and respect throughout the process and will be cremated afterward with ashes available for pick up according to your wishes. Participation is completely optional and will not affect the care, compassion, or attention your pet receives from Peaceful Paws.
Yes, I would like my pet to contribute to veterinary education
No, I would prefer my pet not participate
Payment Option I Prefer:
Cash or check upon arrival
PayPal prior to appointment
Venmo prior to appointment
Credit card link prior to appointment
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Below Is For Office Use Only:
Exam/Treatment/Medications
Follow up sent
Yes
No
Keepsake
Yes
No
Mileage
miles
Payment received (method)
Submit
Should be Empty: