This form is for families that are ready to schedule an appointment and are needing information about available dates/times. Please make sure to review our service area and pricing schedule on our website prior to submitting an inquiry. If you are outside of our service area (cities we serve listed alphabetically), please do not submit a request as we do not travel outside of our listed area.
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
I prefer to be contacted via:
Phone call
Text message
Email
example@example.com
Pet's Name
Type of Pet
Dog
Cat
Other (rabbit, ferret, rat)
Please choose the gender of your pet.
Male
Female
Age of your pet
Weight of pet (can be approximate)
If your pet is a specific breed, please list it here.
Brief reason for euthanasia (mobility, old age, cancer, kidney disease,etc)
Do you need cremation service as well?
Yes, and I wish to have the ashes returned to me (private cremation).
Yes, but I do not wish to have the ashes returned to me (communal/group cremation).
No, I am taking care of the body myself.
I do not know yet.
When are you wishing to have a home visit/appointment scheduled?
Today- my pet's condition cannot wait longer than today for assistance. Please note this may not be available- we will contact you as soon as possible to let you know.
Next availability for my area, likely within the next few days.
In the next week
A specific date in the next 2 weeks- you can let us know the date when we contact you.
Has Dr. Henderson or Dr. Heinemann helped you in the past with another pet?
Thank you for your inquiry. Dr. Henderson or Dr. Heinemann will contact you at the phone number provided as soon as she is able to safely between home visits and driving. If received after business hours, she will reply the next morning.
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