Appointment Request Form

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To request an appointment, please complete the form below. Someone from our team will reach out to discuss availability and help schedule the visit. ♡

Email *

*We will use your email to send relevant paperwork for your appointment only. We do not send marketing emails.*

Appointment Type *

In-Home Euthanasia Visit

In-Home Quality of Life Consultation Visit

Phone number *

Full Address *

Owner First and Last Name *

Pet's Name *

Pet's Breed *

Pet's Gender *

Male

Female

Pet's Age *

Pet's Weight *

Primary Vet Clinic(s) (please specify location) *

Pet's Diagnosis/Reason for Appointment *

Any additional details you would like us to know ♡

Aftercare

If requesting a quality of life consultation, you may still select your aftercare choice and we will note the information on file for the future

Aftercare Options *

Home burial or other arrangements (owner responsibility)

Communal Cremation (no cremains returned)

Private Cremation (individually cremated & the cremains returned)

*For Private Cremation Only*

Your pet's cremains can be picked up directly at the crematory office or we can arrange delivery back to your regular veterinarian's office. The care process is typically completed in a week and the pickup location will contact you once the urn is ready.

Urn Pickup Location

From the crematory's office (Crevasse's - 6950 Philiips Hwy, Suite 42, Jax, FL 32216)

From your primary vet office

Clear selection

If picking up from your vet clinic, please specify which location

Do you prefer to be contacted via call or text? *

Call

Text

Either

A copy of your responses will be emailed to the address you provided.

Submit

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