At-Home Euthanasia Appointment
with Dr Patrick
What Other Families Have Experienced.
"Dr Patrick was amazing, he treated my little dog with the utmost care and respect, it was exactly the send off I wanted for her and she deserved. I recommend the hour visit, he explained everything and we had lots of time to spend with her, well worth every dollar, you won’t be disappointed". Tracey S.
Your Details
Name
*
Prefix
First Name
Last Name
Mobile Number
*
Email Address
*
Address
*
Please include any details on the best place to park, etc.
People attending the appointment and other family members. For children, please include their first names and ages.
*
So that I can include them in my condolence card.
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Your Pet’s Details
Your Pet’s Name
*
Your Pet Is a:
*
Please Select
Dog
Cat
Rat
Mouse
Bird
Guinea Pig
Reptile
Rabbit
Your Pet's Gender
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Male
Female
Sterilised
Not Sterilised
Your Pet’s Details: Breed and Colour
*
My Pet’s Microchip
Is not Microchipped
Has a microchip
Has a MC but don't know the number
Microchip number
Your Pet’s Age
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Pet’s Body Weight
*
In Kgs
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.
Pet’s Diagnosis
*
Age related illness, Cancer, Heart Disease, Kidney Disease, Arthritis, Loss of mobility, Paralysis, Dementia, Diabetes, Blindness Hyperthyroidism, Spinal Disease, Seizures, Cushings, Unknown diagnosis or Other - specify.
Pet's Medical History
Please share any past diagnoses, treatments, medications, surgeries, or other important medical details.
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Please Choose Your Appointment Options
The questions below will allow you to customise how your pets farewell takes place. This helps me prepare the setting that feels right for you, your family and your pet.. Fees are based on your choice of options, I will send you a fee summary shortly.
What matters most to you during your pet’s farewell? Please select one or more options below ❤
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The Perfect Goodbye, a calm, unhurried goodbye, A gentle, peaceful experience with plenty of time to say goodbye. I highly recommend this option for families including especially if children of all ages are present.(Approximately 60 minutes)
A unique and personalised memorial experience. A softly guided, meaningful farewell that may include flowers, candlelight, music, or personal keepsakes, creating a peaceful space to honour your pet’s life. I will gently support you in shaping something that feels right for you and your family. Available as part of The Perfect Goodbye at no extra fee.
A more concise and practical farewell option for families who may prefer a shorter, less elaborate appointment. This option offers calm, dignity, and gentle care, but with a briefer experience. (Approximately 30 minutes)
A Saturday appointment.
A Sunday appointment.
An Out of normal hours visit.
A Behavioural Euthanasia. (For aggression or high anxiety pets).
Fees
Service fees are kept simple and transparent, so everything feels clear and gently taken care of during what can be a difficult time. My Fee is structured in two or three parts: 1. The Euthanasia, Your personalised appointment experience based on your chosen options. 2. Travel, A one-way travel fee to your home. 3. Pet transfer, if required, I can transfer your pet to your chosen cremation facility. Please feel free to contact me with any questions.
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 does not include cremation.
My Pet Transfer Options
*
1. Premium Direct: I will transfer your pet to the Facility immediately after our appointment.
2. Standard Indirect: I will transfer your pet to my home overnight for collection the next day or Monday. (Tuesday if there is a Monday Public Holiday)
3. No Transfer Needed - We will be doing a Home Burial
Other
Cremation Options
Cremation Options — Please note that cremations are charged directly to you 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 only
Option 2. A Flame Cremation. Lawnswood Cremations - Transfer only
Option 3 A Cremation Option without Ashes Returned , includes an indirect transfer by me. The Total Fixed fee (* In addition to the Euthanasia Fee) *
Option 4. No Cremation Needed - We are opting for a Home Burial.
Other
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Payment Options
Pre-Payment is preferred and appreciated.
Your Payment Preference
*
PayID use mobile number 0408 915 550 (No Fees)
EFT - BSB 016 484 Acc 906 172 423
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.
Payment Information
Please Select Your Preferred Appointment Day and Time
I will contact you re an appointment time as close as possible to your requested time
Appointment Availability
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 to confirm.
Are You Claiming the Euthanasia Fees from Pet Insurance
*
No
Yes
Could you please let me know who connected us? If none of the listed options apply, please choose Other and type your answer in the text box.
*
Google/Websearch
Social Media - Facebook
Family or Friend & Name
My Regular Vet
Emergency Vet
Dr Ann Vet
Specialist
I am already a Client
Other
Euthanasia Consent
*
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, and 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
Would you like me to know anything special about your pet before I arrive?
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