Request URLThis field is for validation purposes and should be left unchanged.We understand that this decision does not come easy and that your family seeks a peaceful goodbye to a beloved family member. Please complete this request form and submit it at your convenience. Once we have received and processed your form, we will typically contact you by email within 1-2 business days (Monday through Friday) to discuss availability. Early evening and weekend requests can sometimes be accommodated based on availability and have an additional fee. Pet Owner's First Name*Pet Owner's Last Name*Pet Owner's Home Address*Pet Owner's Email Address* Pet Owner's Cell Phone Number*Pet's InformationPet's Name*Brief summary of your pet's condition or reason(s) for requesting this service:*Pet's Species* Dog Cat Pet's Breed*Pet's Gender* Female Female Spayed Male Male Spayed Pet's Age (in Years)*012345678910111213141516171819202122232425 Consent LinkedInThis field is for validation purposes and should be left unchanged.Please select the most correct statement regarding your pet's interactions with veterinary professions or strangers. For pets that are shy or fearful, or have a history of aggressive reactions at veterinary clinics or with strangers, pre-visit medication may need to be prescribed and given prior to the appointment. Records from your primary veterinarian will need to be submitted for review. *We reserve the right to not euthanize behavioral cases or very reactive pets (those with a very high fear, aggression or stress reaction to veterinary professionals) without a pre-visit consultation (fees apply).* My pet is always sweet and social, have NEVER shown signs of fear (hiding, tail tucked) or aggression. My pet requires medications to be seen at the veterinarian (like trazodone, acepromazine and/or gabapentin). My pet is very fearful of strangers and veterinary professionals, is muzzled and/or medicated for veterinary visits As owner, or authorized agent of the owner, of the animal described in this form, I hereby consent to, and order, euthanasia to be performed on the animal. I further authorize the attending veterinarian to dispose of the remains in the way described on this form.* Yes, I consent No I warrant that all representations and statements contained in this form are true and correct.* Yes, I confirm No I further represent to the best of my knowledge that this animal has not bitten any person or other animal during the past ten (10) days, and is not suffering from or been exposed to Rabies.* Yes, I confirm my pet has not bitten any person or animal in the past 10 days. No I warrant that all representations and statements contained in this form are true and correct.* Yes, I confirm No After Care FacebookThis field is for validation purposes and should be left unchanged.This section is regarding how you would like to have you pet taken care of after the euthanasia. We select the following option for After Care for our pet's remains.* Individual Cremation (the pet will be cremated individually and ashes WILL BE RETURNED). Communal Cremation (the pet will be cremated with other animals and ashes WILL NOT BE RETURENED). Burial at home. (I understand this will require a 6 foot deep burial site to be prepared so that other animals do not disturb the burial site). Pet Memorials* Clay Paw Print Ink Paw Print Ink Nose Print I will select my options from the Pet Portal (for cremation services only).