Lighthouse Euthanasia and Aftercare Consent Form

Lighthouse Euthanasia and Aftercare Consent Form

Please provide your details and preferences for your pet's euthanasia and aftercare options.
Owner's Full Name

First NameLast Name
Owner's Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Owner's Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Owner's Email
example@example.com
Preferred form of communication
Pet's Name
Pet's Age
Pet's Weight (lbs)
Dog, Cat, Other?
Breed
Diagnosis
Pet's Sex
Aftercare Preference for Your Pet's Body
If you decided to get your pet cremated with us, we include up to 2 free clay paw prints. Would you like a paw print? ***this is only available if you get your pet cremated***
How many pawprints would you like?
Each pet gets free ink nose and paw prints. Would you like any ink prints?
Scheduling Preference

Please let us know how soon you would like to schedule.
How soon do you want to schedule?
A member of our team will be reaching out with pricing, and to schedule and/or answer any further questions.
Owner Signature

Please sign to provide your consent.
Should be Empty:

Scheduling Preference