How did you hear about us?
Date you would like the appointment? (yyyy/mm/dd)
Preferred time of day? (required)
Primary Owner's First & Last Name (required)
Other Family Names & Relationships (spouse, child, etc.)
Children Ages (if applicable)
Other Pets in the Household
Province (required) (please select one)
Postal Code (required)
Home Phone Number (required)
Cell Phone Number
Work Phone Number
Your Email (required)
Veterinarian Clinic(s) (required)
Does your pet have health insurance?
(If yes) Name of Insurance Company
Pet Name (required)
Dog or cat?
Pets Age (required)
Spayed / Neutered
Pets Weight (kg)
After care wishes should your pet be euthanized (please select one)
Please select one if applicableHome burialGroup Cremation with no ash returnSemi Private Cremation with ash returnPrivate Cremation with ash return
A few words about what has been going on with your pet.