The Visiting Vet Euthanasia Appointment Request Form

Pet Euthanasia Appointment Request Form

Please complete this form with your details, and we will be in touch as soon as possible. If your request is urgent, please email or call as well so we can make sure we see your message. Please note this is not an emergency service; if we are unable to attend, you may need to contact a local brick-and-mortar practice in an emergency.
Your Details*

First NameLast Name
Contact Number
Email Address*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Are there any issues with accessing your property? Please share any relevant details below if so:
Parking information

Readily available, on streetPlease park on the drivewayParking is by visitor permit which we will provideYou will need to pay to park here (meter parking, multi-storey etc)Other
How urgent is your request at this stage?

I require an emergency appointment today, if available (PLEASE EMAIL, TEXT OR RING AS WELL AS FILLING OUT THE FORM)I require an urgent appointment over the next few daysI require an appointment, but it is not urgentI am registering in advance, I will be in touch when I need an appointmentI have already made an appointment, I'm just leaving you my detailsI am registering to receive information about your services for now, I don't need an appointment
How did you hear about us?

GoogleVet referralRecommendationOther
Pet Details and Background
Pet's name
Species

CatDog
Pet's age or date of birth
Breed and approximate weight (if known)
Sex

MaleFemale
Neutered?

YesNo
Imported from Abroad

Please let us know if your pet has been imported from abroad.
Is your pet imported from abroad?*

YesNo
Where is your pet imported from?
Please complete this if your pet was imported from abroad.
What year was your pet imported?
What is the reason for euthanasia?
Has your pet had any Chemotherapy?*

YesNo
Is your pet difficult to handle or aggressive? NB. you must inform us before the appointment if your pet is aggressive or difficult to handle. We may need to visit in advance to dispense sedatives prior to euthanasia, and/or arrange to bring an assistant. *
Please confirm you understand we reserve the right to leave without refund if we are not told in advance of behavioural issues.*

I understand
What veterinary practice is your pet registered at? (if they are not, type N/A)
It is really helpful for us to be able to let your usual veterinary practice know beforehand (wherever possible) or afterwards about our visit, and to obtain your pet’s medical records. Do you accept this?*

YesNo, I would prefer notNot registered with another vet
Is your pet insured?

YesNo
If yes, who is your pet insured with?
This is a pay in advance/at the time service. How do you wish to pay for your appointment?

Bank transfer in advance (preferred)Cash at time of appointmentCard Payment at time of appointment (£5 transaction fee applied)
Aftercare
Please note: fees for cremation are in addition to euthanasia charges. PLEASE FOLLOW THIS LINK FOR CREMATION OPTIONS AND PRICING
What are your wishes for your pet's body after euthanasia?

Please will you arrange individual cremation through The Visiting Vet Company via PCS. Jess will take your pet with her. (ashes returned IN A SCATTER TUBE IN 7-14 days, no paw prints or hair clippings provided unless we are expressly asked)Please will you arrange individual cremation through The Visiting Vet Company via PCS. Jess will take your pet with her. (ashes returned IN A WOODEN CASKET WITH YOUR PET'S NAME ENGRAVED ON THE TOP IN 7-14 days, no paw prints or hair clippings provided unless we are expressly asked)Please will you arrange individual cremation through The Visiting Vet Company via PCS. Jess will take your pet with her. (ashes returned IN AN ALTERNATIVE VESSEL FROM THE PCS WEBSITE IN 7-14 days, no paw prints or hair clippings provided unless we are expressly asked)Please will you arrange individual cremation through The Visiting Vet Company via Harrogate Pet Crematorium (WEEKDAYS DURING WORKING HOURS ONLY). Jess will take your pet with her. (ashes returned IN A SCATTER TUBE WITHIN 7 DAYS), no paw prints or hair clippings provided unless we are expressly asked)Please will you arrange routine cremation through The Visiting Vet Company. Jess will take your pet with her. (NO ASHES RETURNED, no paw prints or hair clippings provided unless expressly asked)We will arrange collection with/drop off ourselves to Wharfedale Pet CremationsPlease will you arrange Wharfedale Pet Cremations for us (we would like them to collect our pet). We are happy for our details to be passed on to Wharfedale Pet Cremations.Please will you arrange Wharfedale Pet Cremations for us (we would like to take our pet to them ourselves). We are happy for our details to be passed on to Wharfedale Pet Cremations.Please will you arrange Wharfedale Pet Cremations for us (we would like you to take our pet to them for us (+£40-50 depending on size)). We are happy for our details to be passed on to Wharfedale Pet Cremations.We will arrange our own cremation/home burial
Wharfedale Pet Cremations is a bespoke service with a quicker turnaround (within 72 hours wherever possible). Clients can request paw prints, hair clippings, or nose prints through them. The cremation is billed directly by Wharfedale Pet Cremations and arrangements for you to collect ashes from them/have ashes returned by them is organised between yourselves and Jill. If you would like time with your pet after euthanasia, this is a good option for you as you can arrange a convenient time for collection with Jill, or arrange to take your pet to her when you are ready.
Would you like us to take paw prints from your pet? Selecting this option adds an additional fee of +£15.*
Please confirm you understand this is not a 24/7 service - and out of hours, or when I am unavailable, you will need to visit a 'bricks and mortar practice' in an emergency*

I confirm
Data Protection: We will use the information you give us exclusively for the purpose of registering with The Visiting Vet Company*

Please Opt in to having your details held by us
Please read and agree to our Terms and Conditions and Privacy Policy
*

I agree to the terms and conditions and privacy policy
Please verify that you are human*
Should be Empty:

Pet Euthanasia Appointment Request Form

Pet Details and Background

Imported from Abroad

Aftercare