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At Home Euthanasia Form
For more information on at-home pet euthanasia, please complete this form and we will reach out to you.
Contact Information
What can we help you with?
*
I am gathering information and am not yet ready to schedule a visit
I need to schedule a visit
Your Name
*
First
Last
Other family Present
Include any other family members who may be present
Your phone number
*
Your email
*
Address
*
Street Address
City
State / Province / Region
ZIP / Postal Code
Are you a current client?
Yes
No
Pet Information
Your pet's name
*
Gender
Neutered Male
Spayed Female
Male
Female
Unknown
Species
*
Dog
Cat
Rabbit
Small mammal
Weight (kgs)
Age (years)
Breed
Color
Regular Veterinary Clinic
Name & contact
Reason for Visit
Please summarize your pet's current condition and your reason for reaching out
Additional Information
Please share additional information about your pet's personality, comfort with strangers, scheduling requests, or other information.
Service Request Information
Which service are you requesting?
*
Euthanasia: Please ask your veterinarian to email a copy of your pet's recent medical records after scheduling the appoint to info@gvh.ca
Initial Quality of Life At-home Consultation: One hour in-home consultation
Aftercare Services
Communal cremation
Private cremation
Undecided cremation
No cremation: Family will arrange for aftercare
Has your pet bitten a human in the past 10 days and broken skin
*
Yes
No
Δ
Home
About Us
–
Get to know us
Community
Location and Hours
Request an Appointment
–
Prescription Refill & Food Order Form
Payment Options
Cat Boarding Form
Contact Us
–
New Clients
–
What to Expect
New Client Registration Form
–
Services
–
–
Additional Services
Alternative Companion Animals
Anesthesia and Patient Monitoring
Cats Only Clinic
Diagnostic Services
Emergency and/or Extended Care
–
Medical Services
Nutritional Counseling
Pet Supplies
Puppy Socialization Classes
Surgical Services
Wellness Services
Pet Health
–
–
pet health checker
pet health library
Pet Insurance
Pet Loss
Pet Food Recalls
Product Recalls
News
Online Store
x-twitter
facebook
instagram