Before Your Visit

New Client & Pet Information

Please share a few details about you and your pet. This helps me prepare ahead of time so our visit can be as calm and peaceful as possible for everyone.

About You

Pet Parent Name *

Phone Number *

Email Address *

Home Address * The address where our in-home visit will take place.

City *

State *

ZIP Code *

What veterinary clinic does your pet normally visit?

About Your Pet

Pet Name *

Pet Type *

Dog Cat

Breed

Approximate Weight (lbs) *

Pet Age (years) *

Gender *

Male Female

Is your pet nervous around new people? * This helps me approach your pet gently and at their pace.

Yes No

Has your pet bitten a person or animal in the past 10 days? * A standard safety question — your answer won't affect scheduling in most cases, but helps me plan appropriately.

Yes No

Reason for Humane Euthanasia * Sharing a bit about your pet's condition (e.g. quality of life decline, chronic illness, injury, age-related decline) helps me prepare and approach your visit with the right care.

Aquamation Service — if choosing aquamation

Private Communal

Private — Includes urn, 1 clay paw impression, 2 ink nose prints, 1 fur clipping, and 1 gallon of fertilizer at request. You'll receive your pet's remains within 10 days.
Communal — You elect not to receive your pet's remains back to you; they will be respectfully scattered.

Urn Choice — if choosing aquamation

Bamboo Urn

Biodegradable Urn

Bamboo Urn Biodegradable Urn N/A

Once your pet is in their care, Water Bridge Aquamation will coordinate directly with me. I'll let you know how things are progressing, and once your pet's remains and any keepsakes are ready, I'll personally drop them off at your veterinarian's office for you to pick up.

Cremation Service — if choosing cremation

Private Communal

Private — Includes 1 clay paw impression and 1 fur clipping, taken at your request at the time of the appointment.
Communal — You elect not to receive your pet's remains back to you; they will be respectfully scattered.

Cremation Urn Choice — if choosing private cremation

All urns include a complimentary name engraving.

Cedar Memorial Urn

Tan Decorative Metal Urn

Blue Decorative Metal Urn

Scattering Tube

Hand Carved Wood Urn

Ashes Return Preference — if choosing private cremation

Return to my veterinarian's office for pickup I'll pick up at the Lasting Paws facility

If you've chosen cremation, I'll coordinate directly with Lasting Paws Pet Memorial Services on the option you've chosen. Their Centennial location is at 6259 S Troy Cir, Centennial, CO 80111.

Authorization

1. Ownership & Authorization

I certify that I am the legal owner, or a duly authorized agent for the owner, of the pet named above, and that I have full legal right to authorize euthanasia, aquamation (alkaline hydrolysis), and/or cremation for this animal.

I hereby authorize Dr. Grace Krzan of Graceful Journey LLC, along with any authorized agents, staff, or representatives, to humanely euthanize the above-named animal. I further authorize Graceful Journey LLC to arrange for Water Bridge Aquamation to perform aquamation, or Lasting Paws Pet Memorial Services to perform cremation, and final disposition of my pet's remains, in a manner consistent with professional standards and applicable laws within the City and County of Denver, Colorado.

2. Aquamation/Cremation Process & Disposition

I understand that aquamation (alkaline hydrolysis) and cremation are irreversible and final processes that gently reduce the body to mineral ash. I authorize Water Bridge Aquamation or Lasting Paws Pet Memorial Services, whichever applies, to handle and perform this process. I understand that if my pet's remains go unclaimed after 90 days, they may be disposed of in a respectful, non-recoverable manner such as scattering. I acknowledge that Water Bridge Aquamation and Lasting Paws Pet Memorial Services each use a permanent ID tracking system to help ensure the proper return of remains.

3. Rabies Certification (Required by Colorado State Law)

I certify that my response above regarding whether this animal has bitten a person or animal, or been exposed to rabies, within the past 10 days is true and accurate to the best of my knowledge. I understand that if my pet has bitten a person or animal, or been exposed to rabies, within this period, the animal must be tested for rabies after euthanasia, and remains cannot be returned unless authorized following testing.

4. Liability Release & Agreement

I agree to release, indemnify, and hold harmless Graceful Journey LLC, Water Bridge Aquamation, Lasting Paws Pet Memorial Services, and their respective members, managers, agents, staff, successors, affiliates, and employees from any and all liability, claims, losses, damages, demands, attorneys' fees, or costs, whether known or unknown, anticipated or not, arising from or related to the euthanasia, aquamation, cremation, and handling of remains. No warranties, express or implied, are made. Any damages shall be limited to the fees paid for these services.

This writing includes the parties' entire agreement and understanding of the subject matter hereof. This agreement supersedes all prior agreements and understandings between the parties with respect to its subject matter.

This agreement shall be governed by the laws of the state of Colorado.

By signing below, I acknowledge that I have read, understood, and agree to the terms above, and I authorize Graceful Journey LLC, Water Bridge Aquamation, and Lasting Paws Pet Memorial Services to proceed accordingly.

I have read and agree to the authorization above.

Signature (type full name) *

Date *

Your information is sent securely and directly to Graceful Journey. You can also schedule directly on our calendar once you've sent this form.

Thank you.

Your information has been sent to Graceful Journey. I'll be in touch soon.

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