Beloved Waters Aquamation Authorization

Beloved Waters Aquamation

Please fill in the form below
Pet Parent Name *

First Name Last Name
Pet Parent E-mail *
Contact Number: *

Area Code Phone Number
Address: *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Pet Information
Pet Name *

First Name Last Name
Pet Weight (pounds)
Pet Breed
Breed Description
Pet's Gender
Male/Female
Pet's Age
Pet Age
Pet's Status *

Pet is deceased at home. Pet is deceased at veterinary office Pre-Planning. Date space below can be left blank.
Date of Death, or upcoming euthanasia. Leave blank if Pre-Planning.

Month Day Year

Pet Pickup Info
Is Beloved Waters picking up the Pet from your veterinary? *

Veterinary Pickup at the office listed below. *Free I will bring my pet to Beloved Waters. Please contact me to schedule a time. *Free Please contact me to make arrangements to pick my pet up at my home. *There is an additional charge for home pickup. Pre-Planning. Pick up To Be Determined.
Veterinary Hospital
Veterinary Hospital Name
Veterinary Phone Number

Area Code Phone Number

Details about each package can be found on our services page.

Aquamation Service Selection *

Eco (Individual with ink paw print, fur clipping and Paw Pod urn) Deluxe (Individual with clay paw print, fur clipping and photo Urn) Communal (No ashes returned)
Would you like any additional memorial items such as a different urn, additional paw prints...etc.
If yes, please write a brief description of any additional memorial items you would like to add.
All online forms are reviewed during office hours. Our office hours are 9a-5p Monday - Friday and Saturday 9a-noon, all office hours are currently by appointment only.

Outside of office hours we offer pickup service for an additional fee, and you will need to call Beloved Waters at 615-295-8934 to make us aware of the After Hours need.
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Beloved Waters Aquamation