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.
Pet's Name*
Pet's Age*
Pet's Weight (lbs)*
Dog, Cat, Other?*
Breed*
Diagnosis*
MaleFemale
Communal cremationPrivate CremationAt home burial
YesNo
How many pawprints would you like?
YesNo
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