First and Last Name

At-Home Euthanasia Appointment

with Dr Patrick
Thank you for your enquiry regarding a peaceful pet euthanasia in the comfort of your home with Dr Patrick from Ark Angel Vet.

I aim to bring your pet Respect, Compassion, Dignity and Peace during your at-home appointment. Also, to create a meaningful experience that honours your beloved pet.

If you have any questions regarding my approach during this very difficult time, please contact me directly on 0408 915 550.

You may find it helpful to view some of my Clients' Reviews on Google via this link:

Google Reviews Link Ark Angel Vet
https://arkangelvet.com.au/reviews/

My Ark Angel Vet Website:

https://arkangelvet.com.au
Your Details
Name*

PrefixFirst NameLast Name
Mobile Number *
Email Address*
Address*
Please include any details on the best place to park etc.
People attending the appointment & other family members. For Children their First names and their ages. *
So that I can include them in my condolence card.
Your Pet’s Details
Your Pet’s Name *
Your Pet is a:*

DogCatOther
Your Pet’s Details: Breed & Colour*
My pet's Microchip:

Has a microchipIs not Microchipped
Your Pet’s Microchip Number
Please enter the microchip number (if known)
Your Pet’s Age*
Your Pet's Gender*

MaleFemale
Pet’s Body Weight*
In Kgs
Pet’s Diagnosis *
Age related illness, Cancer, Heart Disease, Kidney Disease, Arthritis, Loss of mobility, Paralysis, Dementia, Diabetes, Hyperthyroidism, Spinal Disease, Seizures, Cushings, Unknown diagnosis or Other - specify.
Your Pet's Behaviour*

Very friendly.May be anxious - with strangers.May be Reactive or Aggressive and a potential bite risk. May need pre visit Meds, or extra Sedative doses, that will incur an extra fee.Behavioural Euthanasia for Aggression - Will need pre visit Meds, and extra Sedative doses, Fee is from am extra.
Your Pet’s Regular Vet is (Vet Name)*
Your Pet’s Regular Veterinary Practice*
You can add any recent Specialty Centre or Emergency Hospitals visits.
Regular Veterinary Hospital phone number
Please neter the number if known. I will call them to inform them of your pet’s passing.
Fees - There are 3 Components to my Fees:

1. Euthanasia Fee 2. Travel Fee 3. Transfer Fee to Cremation Facility (if required). Once you have selected your options we will be in touch with a total fee for you.
Choose Your Appointment Type

If you are not sure please text or call Dr Patrick on 0408 915 550. Or fimd out more here: https://arkangelvet.com.au/pricing/
Select your specific Service:*

The Pefect Goodbye (Chosed by 95% of clients) - One Hour Visit. Mon - Fri.Saturday. Weekend surcharge applies.Sunday morning 9 am, one appointment only, surcharge applies.Exotic Pet Visit - Rabbit, Rat, Bird or Guinea PigEmergency Appointment a visit within 2 hours of first contact. (Travel fees may apply if your pet passes while I am on my way. From $0 to $295)Procedural Euthanasia - 30min only. Mon-FriBehavioural Euthanasia (For aggression - Includes pre-sedation tabs)Special Location, Park, River or Beach (up to a 2 hour visit)Two Pet Euthanasia's at the same VisitFinancial Hardship Option: Ask Dr Patrick if you are not able to afford the standard fees, he will try to help with some options.
Post Appointment Transfer Options

If required I can transfer your pet after our visit.* Please note: The costs of your pet's transfer after our appointment are in addition to the above Euthanasia fees and do not include cremation.
Pet Transfer*

1. Premium Direct - $1952. Premium Direct Transfer - Afterhours (Lawnswood Only) - $2953. Standard Indirect Transfer - $1504. Transfer to Murdoch Uni (Education Donation) - $1955. No Transfer Needed - We will be doing a Home BurialOther
Cremation Options - Please note Creamtions are charged directly by the respective companies.*

Option 1. A Water Based Cremation. Ripple Aquamation ( This is my Primary Recommendation) https://rippleaquamation.com.au. Is an Environmentally sustainable and economical option. Transfer onlyOption 2. A Flame Cremation. Lawnswood Cremations - Transfer onlyOption 3. Murdoch University Education Donation - Transfer Only FeeOption 4. A Cremation Option without Ashes Returned , includes transfer by me. The Total Fixed fee (* In addition to the Euthanasia Fee) *Option 5. No Cremation Needed - We are opting for a Home Burial.Other
After your fee is confirmed, I would gently recommend pre-paying so that during our appointment, we can focus entirely on supporting you and your beloved pet through a peaceful and loving goodbye.

I will confirm your total fee when confirming your appointment time.

You can use PayID by entering my mobile number 0408 915 550. Once you’ve made the payment, please send me a quick text with your receipt. I will bring a printed receipt for you to our appointment.

Unfortunately I do not have the ability to extend credit or payment options at this time. Payment is preferred before or at the time of the visit.
Payment Options

Pre-Payment is Preferred.
Payment Preference*

PayID use mobile # 0408 915 550 (No Fees)Credit Card over phone (Fees apply)Credit Card at the end of our visit (Fees apply)Debit Card at the end of your visit. A physical card is required (30 cents flat fee)Cash
Appointment Availability
Please select your Preferred Appointment Day and Time

I will contact you re an appointment time as close as possible to your requested time
If you are not able to find your ideal time please fill in your day and time in this box. Dr Patrick will contact you.
Are you claiming the Euthanasia fees from Pet Insurance*

NoYes
Could you please let me know who connected us, so I can a pass on my gratitude.*

Google/WebsearchSocial Media - FacebookFamily or Friend & NameMy Regular VetEmergency VetDr Ann VetSpecialistI am already a ClientOther
Euthanasia Consent *

Powered by Jotform SignClear
I consent to the euthanasia of my pet to be performed by Dr Patrick Africano. I also understand that Dr Patrick may use audio recording during the visit to assist in completing the medical record. Please submit your consent by clicking the button below
Questions, Concerns, Special Requests - Or if you need clarification regarding any of the options.
Please let me know if you have any particular requests or concerns.
Please text me after signing and submitting this form.

*If this form is not submitting please check for a Red notice in the form above for a required field to be completed. I will then confirm your total fee and your appointment time. Dr Patrick: 0408915550
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At-Home Euthanasia Appointment

Your Details

Your Pet’s Details

Fees - There are 3 Components to my Fees:

Choose Your Appointment Type

Post Appointment Transfer Options

Payment Options

Please select your Preferred Appointment Day and Time

Please text me after signing and submitting this form.