Client Registration Form Home » Client Registration Form Share Please fill out the form below. The more information we have about your pet, the better we’re able to serve you. Appointment Information How did you hear about us? Type of Appointment Quality of Life AssessmentHumane Euthanasia Request What day or days work best for you? SundayMondayTuesdayWednesdayThursdayFridaySaturdaySunday What time of day works best for you? Please select oneMorningAfternoonEveningAnytime Contact Information Your Full Name (First and Last) Your Phone Number Your E-Mail How would you like to be contacted? PhoneE-MailEither Street Address City Province Postal Code Pet & Household Information Other Pets in the household (if applicable) Children's ages in the household (if applicable) Pet Insurance Company (if applicable) Pet Name Species Please select oneDogCatOther Breed Color Sex MaleFemale Spayed/Neutered YesNo Pet's Weight (Best guess in lbs if unsure) Aftercare Wishes (if humane euthanasia requested) Private CremationCommunal CremationHome Burial Tell us what's going on A few words about what has been going on with your pet