When you are ready to make an appointment with me for at-home euthanasia of your pet, please fill out this form and hit "send email".  I will then contact you within a few hours to make the final arrangements.

Providing this information now helps me make the procedure as smooth as possible and allows me to focus on you and your pet when I come to your house.

Please note: I provide at-home euthanasia service Monday, Wednesday, and Friday from 8 AM to 5 PM and Tuesday/Thursday at 5:30 PM.  If you submit this form after 5 PM or over the weekend, I will contact you the next business day.

Name
Address
City, State, Zip
Phone
Email
Pet's name
My pet is a	Cat   Dog
My pet is	Female   Male
Pet's age
Pet's breed (if known)
Pet's color/markings
Reason for euthanasia	Just give as much info as you can. I'll discuss this more fully with you when I speak with you.
Your pet's primary veterinarian
Any additional information about you or your pet that may be helpful
Your aftercare choice for your pet	Undecided   Request transport for mass cremation   Request transport for private cremation   Will handle aftercare arrangements yourself
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