Form - Rest Well Pet Memorials

First Name*

Last Name*

Phone*

Email

Intake Date*

ID Number*

Total Due

Deposit Paid

Pet's Name*

Sex*

Species*

Breed

Weight

Date of Passing

Paw Prints, Etc.

Clay Paw Print

Ink Paw Print

Clay Nose Print

Ink Nose Print

Fur Clip

Return Whiskers

Return Microchip

Special notes or requests for multiples

Items to return?

Yes

No

Please provide a brief description

Bone Cleaning

Skull Only

Whole Skeleton

Other, custom cleaning

None

Does client want skeleton articulated?

Yes

No

Describe base and pose

Describe custom bone cleaning request

Hide Tanning

Describe location, shape, any markings to include, etc:

Does client want hide:

Lay flat (cut along belly area)

In-tact, tube shaped

Taxidermy

Paw(s)

Ear(s)

Tail

Other

Taxidermy Notes*

Cremation

Private, ashes returned

Group, no ashes

Additional Notes