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Euthanasia Facility Online Registration

You must answer all questions completely and precisely. Misstatements, fraudulent, or insufficient answers and data required will be reason for rejection of your application.

While you are in the online registration, please do not use the back button in your browser. If at any time you wish to exit the process, please click the "Exit" button located at the bottom of the page.

If you will be away from your computer for any period of time after starting your online application, it is strongly advised that you click on the "Save for Later" button located at the bottom of each page to minimize the risk of losing the data that you have input into the system. You can then log back into the application at a later time by clicking on the "Continue Saved Euthanasia Facility Registration" button in the menu.

Applicant Information

Physical Address

If your county is not listed,
please select Not in WV.

Mailing Address

If your county is not listed,
please select Not in WV.



Page Updated: 3/29/2016 11:29:36 AM