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 and you will not receive a response.
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.
Format: (000) 000-0000.
Our preferred first contact is text message as we are driving or in appointments most of the day, and this method can be done safely and quickly in between appointments. We can certainly also call you after text contact, but likely will be towards the end of our day when we are no longer driving. Please indicate if your phone is a landline and you are unable to accept text messages (again, phone calls may have to wait until the end of the day).
*
I have a landline and cannot accept text messages.
Text messages are fine as first contact.
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.
Reason for euthanasia (mobility, old age, cancer- please list what type or source, kidney disease, dementia,etc). Feel free to be as detailed as you wish. You may also list medications you are giving.
*
Please list your regular veterinarian's hospital name (not your specific vet's name) and any other name your pet's record may be listed under (your spouse, partner, daughter,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.
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- see the next question.
If you are requesting a specific day or timeframe (morning/afternoon), please indicate your needs here.
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 may need to reply the next morning.
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