First Name *
Last Name *
Are you an Alcor Member? * YesNo
Alcor Number (If applicable)
Pet Name *
Species * DogCatOther
If ‘Other’ is selected, list the species
Weight (Lbs.) *
Cryopreservation Option * Whole-Body PreservationNeuropreservationBoth
Cryopreservation Type * Straight-FreezePerfusionBoth
Please note: Perfusion is only available for pets that are able to be transported to Alcor at the time of euthanasia. Remote services are not available at this time.
Measurements for Neuropreservation in Inches – If you are not interested in a neuropreservation quote, enter 0
Head Length from the tip of the nose to the back of the head *
Head width at the widest part *
Head height at the tallest point *
Measurements for whole-body preservation in Inches – If you are not interested in a whole-body preservation quote, enter 0
Length from the base of the skull to the base of the tail *
Width at the widest part of the animal *
Height of the rib cage *
Is the pet alive? * YesNo
If no, provide the date of death
If no, please describe how the pet has been stored since the death occurred. List location, temperature, and condition.
I affirm and certify that all the information and answers to questions herein are complete, true and correct to the best of my knowledge and belief. I understand that any misrepresentation, falsification, or omission of any facts called for in the application may affect the cost of cryopreservation and may result in delay or inability to perform the procedure. *
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3 + 0 = ?Please prove that you are human by solving the equation *
7895 E Acoma Drive, Suite 110
Scottsdale, AZ 85260
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