Pet Home Euthanasia Request Form **If your pet needs an urgent appointment, call or text us at 706-577-4365 after submitting this form. Please note that same day and next day appointments are often unavailable, and will incur an emergency fee. *Name(Required)Phone(Required)Email(Required) Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Pet's Name(Required)Species(Required) Dog Cat Horse Goat Pig Gender(Required) Male Male Castrated Female Female Spayed Breed(Required)Color(Required)Age(Required)Estimated Weight(Required)Please briefly explain the circumstances or illnesses leading up to your decision(Required)Veterinarian's NamePhone NumberWould you like for us to notify their office? Yes No Please select from the following:(Required) In home euthanasia only (no after care needed). Please understand that if your residence is within Columbus city limits, local ordinances prohibit home burial. In home euthanasia with private cremation (ashes will be returned). In home euthanasia with communal cremation (ashes will NOT be returned). How soon are you looking to schedule an appointment?Please note that same day and next day appointments are often unavailable, and will incur an emergency fee. Appointments are scheduled Monday-Friday only, and typically 2-3 weeks in advance for new clients. If you would like, please upload a picture of your pet. (With an option to upload, and this section is not mandatory) FileMax. file size: 8 MB.Please understand that appointment times are limited. If you must cancel your appointment, we respectfully request 48 hours notice. Missed appointments, or appointments cancelled without 48 hours notice, will incur a fee equal to your trip fee.(Required) I acknowledge this statement. Signature
