Client Intake Form in San Diego, Riverside, & Orange County

Client Intake Form

Have you already submitted an appointment request via our website?(Required)

Yes

Appointment Date Requested

Name(Required)

First Last

Phone(Required)

Address(Required)

Street Address Address Line 2 City ZIP / Postal Code

Email(Required)

Pet's Name(Required)

Species(Required)

Breed(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)

Will Paws into Grace be taking care of the cremation?(Required)

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