Euthanasia Request

We are sorry that you are faced with this difficult decision. We know how difficult it can be, as we have been there with our own pets. Please fill out the following form, so that we can asssist you in making that decision, answering questions or helping with a peaceful crossing over for you pet. IF YOU HAVE NOT HEARD BACK FROM US WITHIN 1 HOUR during regular working hours, please email us at [email protected] or call 201-803-7705

* Indicates required field

Owners Full Name *

First

Last

Complete Address *

Line 1

Line 2

City

State

Zip Code

Country

Cell Number INCLUDE DASHES. Please make sure to put dashes in the appropriate places of the phone number *

Email *

Pets Name *

Choose One please *

Dog Cat

Pet's Breed (if it is a mix, what is it a mix of?) *

Pet's Weight at last veterinary visit. (This is used to calculate drug dosages) *

Pet's Age *

Sex *

Male Femal

Reason for euthanasia (Diagnosis/Symtoms) *

For aftercare, do you want a private cremation (where you get the ashes back); or a group cremation (where you do not get the ashes back)? *

How is your pet with strangers coming into the home or at the veterinary clinic? At the veterinary clinic, do they growl, try to bite, scratch, jump or try to run away? Do they usually need a muzzle or anxiety medication to go to the vet? *

Regular Veterinary Hospital / Clinic name *

Who referred you? *

Specifically, when are you requesting our services for:Today? Tomorrow? Later this week? Next week? *

Submit

PLEASE MAKE SURE TO HIT SUBMIT BUTTON. If you hit submit, and you do not get a IMMEDIATE pop up response that your form has been submitted, please resubmit form at JOTFOM by clicking here, Jotform , to be redirected to another site with the form

Payment is due at the time that services are rendered. We take cash, check, zelle and credit cards.