About You

First Name *

Last Name *

Phone *

Email *

Address *

About Your Pet

Pet's Name *

Pet's approximate weight in kilos *

up to 10kgs
10.1 to 15kgs
15.1 to 20kgs
20.1 to 25kgs
25.1 to 30kgs
30.1 to 35kgs
35.1 to 40kgs
40.1 to 45kgs
45.1 to 50kgs
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Type of pet *

Color of pet *

Pet's Gender *

Male

Female

Pet's Date of Birth *

Has your pet passed? *

Yes
Not yet - to be put to sleep
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Pet's Date of passing/to be put to sleep *

Time to put to sleep *

We ask for your truthful answer below as we have health protocols to follow for everyone's safety.

Pet's cause of death *

Old age/natural causes
Parvo
Distemper
Rabies
Chronic Kidney Disease/CKD
Erlichia/Blood Parasite
Leptospirosis
Other or Unknown
Other infectious disease
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Cause of death if other

IMPORTANT: Please note that for death from an infectious disease like Rabies, Parvo, Distemper or Leptospirosis, we will not be able to hold a send-off before the service due to sanitation reasons. Follow our steps here on how to handle the remains until the service.

Would you like to use the Send-off Hall prior to the service (free of charge)? *

To spend some time with your pet

Yes
No
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How would you like to be contacted? *

Email

Call

SMS

How did you find out about us? *

Through our vet
Through social media
Google/search engine
Word of mouth
Other
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Vet/Clinic Name *

By checking this box, I agree to the terms of service.

By checking this box, I agree to the privacy policy.

I, the undersigned, certify that:

I am the legal owner of the pet described in this request
I have full authority to arrange for their cremation
I authorize Green Meadows Pet Aftercare Services Inc. to perform cremation services
I release Green Meadows from any liability related to these services

Your signature *

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