Request a Visit DO NOT USE

Step 1 Your Info

First & Last Name *

Phone *

Email *

Address *

City *

Zip *

Requested Service *– Select Option –Euthanasia VisitComfort Care VisitCremation PickupAcupuncture Visit

State MN/WI

Date preferred

Time preferred— Select One —MorningEarly AfternoonLate AfternoonEvening

Body Care *– Select Option –Group (no ashes return)Individual (ashes returned)No body careUnsure

Body Care *– Select Option –Group (no ashes return)Individual (ashes returned)

Ashes Return Options – Select Option –Home Delivery $25Pick up at your clinic $0Undecided

Special instructions | Other family present