Appointment Request Form

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Are you requesting one of the below services;* This field is required.Home Euthanasia Pet Hospice/Palliative Care Pain Management (acupuncture, laser therapy) Quality of Life Consultation Tele-Advice Virtual Visit Virtual Visit: Follow-up/General questions
Yes
No
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Please let us know which service you are requesting* This field is required.
In-Home Euthanasia
Pet Hospice/Palliative Care, pain managemnet or Quality of Life Consultation
Tele-Advice Virtual Visit
Virtual Visit: Follow-up/general questions
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The past two years have presented many challenges locally and worldwide. I am proud and happy to have been able to provide veterinary care for so many pets in my community throughout 2020 and 2021. I am grateful for every one of my clients that entrusted their beloved companions in my care. Thank you.

Moving forward, House Call Vet RVA will only be providing hospice & palliative care and end-of life services.

I want to thank the members of my community that are inquiring about wellness home visits and sick pet visits. I feel honored and thank you for your interest.

Sincerely,
Kaitlyn Hemsley, DVM
House Call Vet RVA
804-382-3684
info@housecallvetrva.com

01/01/2022
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Important Update

Due to limited staffing we are currently not accepting new patients for the service you have requested.

We apologize for any inconvenience and encourage you to sign up to receive our newsletter for practice updates, by clicking "NEXT" to enter your name and email address.
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Name* This field is required.
Prefix
First Name
Last Name
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Email* This field is required.
example@example.com
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Phone Number* This field is required.
Please enter a valid phone number.
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Can you receive text messages at this number?* This field is required.
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Address* This field is required.
Street Address
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Namibia
Nauru
Nepal
Netherlands
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New Caledonia
New Zealand
Nicaragua
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Nigeria
Niue
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South Ossetia
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eSwatini
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Isle of Man
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Other
Country
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Pet’s Name* This field is required.
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Species* This field is required.
Canine
Feline
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Breed* This field is required.
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Color* This field is required.
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Sex* This field is required.
Male
Female
Male, Neutered
Female, Spayed
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Date of Birth * This field is required.
Patient’s Date of Birth
Month
Day
Year
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Pet’s Weight (in pounds)* This field is required.
Patient’s Weight (in pounds)
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Who is your pet’s current veterinarian? * This field is required.
Primary Veterinary Clinic
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Please tell us a little about what is going on?* This field is required.
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Please use the space below to share the names of any family and/or friends that will be present. *This is not required and the information will only be used to help make your pet’s appointment a more personable experience.
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Anything else you would like us to know?
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How did you hear about us?* This field is required.
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Aftercare Request* This field is required.
Private cremation with return of ashes
Communal cremation with no return of ashes. My pet's remains will not be retuned to me.
Home burial. I wish to keep my pet's body at home for my own burial.
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Please let us know which day you would like to make your appointment for?* This field is required.
Sunday
Monday
Tuesday
Wednesday
Friday
Saturday
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Preferred Appointment Day* This field is required.
Monday
Friday
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Preferred Time of Day* This field is required.
Morning
Afternoon
Evening
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Please let us know an alternative day you would like to make your appointment for?* This field is required.
Sunday
Monday
Tuesday
Wednesday
Friday
Saturday
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Alternative Appointment Day* This field is required.
Monday
Friday
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Alternative Time of Day* This field is required.
Morning
Afternoon
Evening
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Today's Date* This field is required.
Date
Year
Month
Day
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