Client Intake Form Have you already submitted an appointment request via our website?(Required) Yes No Appointment Date Requested MM slash DD slash YYYY Name(Required) First Last Phone(Required)Address(Required) Street Address Address Line 2 City ZIP / Postal Code Are there any specific parking/driving directions or gate codes required to access your home? (If yes, please include details below.)(Required)How many children will be present at the appointment?(Required)If children will be present, what are their ages?Email(Required) Pet's Name(Required)Pet's Gender(Required) Male - Neutered Male - Intact Female - Spayed Female - Intact Species(Required)CanineFelineOtherBreed(Required)Pet's Age(Required)What is your pet's weight (in pounds)?(Required)What color(s) is your pet?(Required)Who is your pet's regular vet clinic?(Required)Please share some details about your pet's condition and the reasons for scheduling the appointment.(Required)Will Paws into Grace be taking care of the cremation?(Required)Yes, I want my pet's ashes back (Individual Cremation)Yes, I want my pet's cremated ashes spread at sea (Communal Cremation)No, I will take care of my pet after the appointment (No Aftercare)Would you prefer to have your pet's ashes hand delivered to your home for an additional fee?(Required) Yes No Is your pet friendly with strangers?(Required)What does your pet do with strangers in your home?(Required)Have you been exposed to or tested positive for Covid in the last 2 weeks?(Required)I acknowledge the following protocols:(Required) I/we will give 2+ hours notice if we need to reschedule or cancel the appointment to avoid a cancellation fee What is your timeline for this service?(Required) Immediately / As Soon As Possible Today In 2-3 Days Within the next week Within the next two weeks Unknown / I am planning
