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 2 HOURS during regular working hours, please e-mail us at [email protected] or call 201-803-7705
If you are having problems with the form below, please click Jotform to be redirected to another site with the form (our webserver is working on fixing the form, so Jotform may need to be used in the interim)

* Indicates required field

Owners Full Name *

First

Last

Complete Address *

Line 1

Line 2

City

State

Zip Code

Country

Cell Number INCLUDE DASHES *

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? *

Please monitor your emails (or spam folder) for response to this form. Please respond to e-mail, so that we know you have received it. Thank you! *

Submit

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