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Client/Pet Intake Form
Aftercare & Remembrance Items
Quality of Life Assessment
Home
About Us
Services
End-of-Life Comfort Care
Pain Management
Acupuncture
Laser Therapy
Palliative Care
At-Home Euthanasia
Cremation & Aftercare
Remembrance Items
Grief & Loss
FAQ and Pricing
Contact Us
Forms
Client/Pet Intake Form
Aftercare & Remembrance Items
Quality of Life Assessment
Contact Us
End-of-Life Comfort Care
Home
End-of-Life Comfort Care
Services
Pain Management
Acupuncture
Laser Therapy
Palliative Care
Aftercare & Remembrance Items
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Please enable JavaScript in your browser to complete this form.
First and Last Name
*
Pet's Name
*
Aftercare (cremation pricing listed on our FAQ/Pricing page)
*
Home Burial - I will provide my own bag/box
Home Burial - Biodegradable Bag provided by Gentle Journey ($20)
Group/Communal Cremation (ashes scattered on private property in Morgan, Utah)
Private/Individual Cremation (ashes returned) - Complimentary Box Included - Please Select Metal or Wooden Box Below)
Box Selection (One wooden box or metal tin included with private cremation. Select "Yes" to see options)
*
Yes
No
Box Selection
*
Metal Tin
Cedar Box - with clasp and lock
(Beautifully handcrafted aromatic cedar urn with a lid, secured using a clasp and lock with key. This option allows easy access if needed. Each urn can be personalized to best memorialize your pet.)
Cedar Box - Sealed
(Beautifully handcrafted aromatic cedar urn with a smooth, sealed finish and screw-on base. This option provides a clean and secure closure. Each urn can be personalized to best memorialize your pet.)
Walnut Box with clasp and lock
(Beautiful handcrafted walnut urn with a lid, secured using a clasp and lock with key. This option allows easy access if needed. Each urn can be personalized to best memorialize your pet.)
Walnut Box - Sealed
(Beautiful handcrafted walnut urn with a smooth, sealed finish and screw-on base. This option provides a clean and secure closure. Each urn can be personalized to best memorialize your pet.)
Additional Box ($38)
*
Yes
No
Additional Box Type
Metal Tin
Cedar Box with Clasp & Lock
Cedar Box - Sealed
Walnut Box with Clasp & Lock
Walnut Box - Sealed
Engraving (for Cedar and Walnut Boxes Only) - Includes 2 lines of engraving - Additional lines $10 per line
*
Yes ($24)
No
Engraving Detail
Clear Signature
Please draw the engraving details as if this were the lid of the box, including text and clipart placement.
Font Selection
*
font 1
font 2
font 3
font 4
font 5
font 6
font 7
font 8
Clip Art ($12 per image)
*
No Clip Art
Clip Art 1
Clip Art 2
Clip Art 3
Clip Art 4
Clip Art 5
Clip Art 6
Clip Art 7
Clip Art 8
Clip Art 9
Clip Art 10
Clip Art 11
Please include as much detail as possible regarding engraving/clipart size and placement
*
Additions to Wooden Boxes
*
No Additions
Metal Plate over Lid - No Engraving ($22)
Metal Plate over Lid - with Engraving ($46)
Plexiglass over Lid ($22)
Your Pet's Paw Print engraved on lid ($38)
Premium Metal Urn Selection (Small 1-50 pounds $96) (Large 50-125 pounds $125) - Select "Yes" to see options
*
Yes
No
Premium Metal Urn Size
*
Small Metal Urn
Large Metal Urn
Premium Metal Urn Style
*
Gold with 3 Rings
Silver with 3 Rings
Gold with Paw Prints
Silver with Paw Prints
Paw Prints (Ceramic, Granite, Glass tile) *Please allow 6-8 weeks for delivery of Ceramic Paw Prints
*
Yes
No
Name on Paw Print
Paw Print Types
Ceramic Paw Print ($75 each)
(Available colors - Blue, Pink, Black, Purple, Red)
Ceramic Paw Print Quantity
*
--- Select Quantity ---
1
2
3
4
5
Paint Color 1
*
--- Select Color ---
Blue
Pink
Black
Purple
Red
No Paint
Ribbon Color 1
*
--- Select Color ---
Blue
Pink
Black
Purple
Red
No Ribbon
Paint Color 2
*
--- Select Color ---
Blue
Pink
Black
Purple
Red
No Paint
Ribbon Color 2
*
--- Select Color ---
Blue
Pink
Black
Purple
Red
No Ribbon
Paint Color 3
*
--- Select Color ---
Blue
Pink
Black
Purple
Red
No Paint
Ribbon Color 3
*
--- Select Color ---
Blue
Pink
Black
Purple
Red
No Ribbon
Paint Color 4
*
--- Select Color ---
Blue
Pink
Black
Purple
Red
No Paint
Ribbon Color 4
*
--- Select Color ---
Blue
Pink
Black
Purple
Red
No Ribbon
Paint Color 5
*
--- Select Color ---
Blue
Pink
Black
Purple
Red
No Paint
Ribbon Color 5
*
--- Select Color ---
Blue
Pink
Black
Purple
Red
No Ribbon
Paw Print Types
Granite Polymer Paw Print ($75 each)
(Available colors - Blue, Pink, Black, Purple, Red)
Granite Polymer Paw Print Quantity
*
--- Select Quantity ---
1
2
3
4
5
Ribbon Color 1
*
--- Select Color ---
Blue
Pink
Black
Purple
Red
No Ribbon
Ribbon Color 2
*
--- Select Color ---
Blue
Pink
Black
Purple
Red
No Ribbon
Ribbon Color 3
*
--- Select Color ---
Blue
Pink
Black
Purple
Red
No Ribbon
Ribbon Color 4
*
--- Select Color ---
Blue
Pink
Black
Purple
Red
No Ribbon
Ribbon Color 5
*
--- Select Color ---
Blue
Pink
Black
Purple
Red
No Ribbon
Paw Print Types
Glass Tile Paw Print ($68 each)
(Available colors - Black, Blue, Green, Red, and Brown)
Glass Tile Paw Print Quantity
*
--- Select Quantity ---
1
2
3
4
5
Glass Color 1
*
--- Select Color ---
Black
Blue
Green
Red
Brown
Glass Color 2
*
--- Select Color ---
Black
Blue
Green
Red
Brown
Glass Color 3
*
--- Select Color ---
Black
Blue
Green
Red
Brown
Glass Color 4
*
--- Select Color ---
Black
Blue
Green
Red
Brown
Glass Color 5
*
--- Select Color ---
Black
Blue
Green
Red
Brown
Ink Prints (5 prints on card stock)
*
Yes
No
Ink Print Type(s)
Ink PAW Prints ($25 for 5 cards)
Ink Paw Print Quantity (One set = 5 cards, two sets = 10 cards, etc.)
*
--- Select Quantity ---
5 Cards
10 Cards
15 Cards
20 Cards
25 Cards
Ink Print Type(s)
Ink NOSE Prints ($42 for 5 cards)
Ink Nose Print Quantity (One set = 5 cards, two sets = 10 cards, etc.)
*
--- Select Quantity ---
5 Cards
10 Cards
15 Cards
20 Cards
25 Cards
Necklaces (Only available with Private Cremation - Each necklace is able to hold a small amount of ashes) - Select "Yes" to see available style options
*
Yes ($52 each)
No
Necklace
Tear Drop Shape "Faithful Friend"
Quantity for Teardrop Shape Necklace with "Faithful Friend" Writing
*
--- Select Quantity ---
1
2
3
4
5
Necklace
Heart Shape with Blue Rinestone Heart Paw
Quantity for Heart Shape Necklace with Blue Rinestone Heart Paw
*
--- Select Quantity ---
1
2
3
4
5
Necklace
Heart Shape with Pink Rinestone Heart Paw
Quantity for Heart Shape Necklace with Pink Rinestone Heart Paw
*
--- Select Quantity ---
1
2
3
4
5
Necklace
Heart Shape with Black Paw Prints
Quantity for Heart Shape Necklace with Black Paw Prints
*
--- Select Quantity ---
1
2
3
4
5
Necklace
Cylinder Shape with Black Paw Prints
Quantity for Cylinder Necklace with Black Paw Prints
*
--- Select Quantity ---
1
2
3
4
5
Necklace
Round with Black Designs and Paw Print
Quantity for Round Necklace with Black Design and Paw Prints
*
--- Select Quantity ---
1
2
3
4
5
Necklace
Paw Print shaped Necklace with clear Rhinestones
Quantity for Paw Print shaped Necklace with clear Rhinestones
*
--- Select Quantity ---
1
2
3
4
5
see Ink Additions
Picture Frame with Clay Paw Print
*
Yes ($68)
No
Picture Frame with Clay Paw Print Quantity
*
--- Select Quantity ---
1
2
3
4
5
Agreement
I confirm my contact information and Pet's information is correct. I understand that Gentle Journey Veterinary Care will be transferring my pet's care to Wasatch Family Pet Services and they will deliver any ashes and/or remembrance items I have selected to the address I have listed on the Service Agreement form. I understand that Gentle Journey is not responsible for my pet once my pet has been transferred to Wasatch Family Pet. I also understand that I am financially responsible for all associated costs.
Signature
*
Clear Signature
Printed Name
*
Date
*
Send to Myself
*
Yes
No
Email
*
Submit
