In-Home Euthanasia Request Form
Our Comfort Care Nurse, Leah, will reach out to you regarding scheduling within 12-24 hours. Please note that pets weighing more than 30 lbs. may require additional time for scheduling. Pricing for services is available online at https://bit.ly/inhomepricing.
Your Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Address where services will be performed?
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
When are you hoping to schedule your pet’s in-home euthanasia appointment?
*
As soon as possible (urgent request for following day)
Within the next few days
Sometime over the coming weeks
Other
Our provider is only able to assist families who's pet have been seen for an exam by one of Tipp City Veterinary Hospital's doctors within the past 12 months. Does the pet you're requesting services for meet this criteria?
*
Yes, my pet has had an exam at TCVH within the past 12 months
No
I'm not sure
No, but I would like to get an exam scheduled with a TCVH doctor so in-home euthanasia can be an option
Pet's Name
*
Pet's Species
*
Dog
Cat
Other
Pet's Approximate Weight
*
Pet's Gender
*
Male
Female
Please describe what you are seeing at home that has you contacting us for a in-home euthanasia appointment?
*
Will other pets be in attendance?
*
Yes
No
Maybe
Where in your home or on your property would you like services to take place?
*
What are your wishes for aftercare?
*
Private Cremation ($349) by Faithful Companion (Ashes returned to family)
Memorial Cremation ($137) by Faithful Companion (Ashes not returned to family)
Burial at home
I'm unsure and would like more information
Other
Do you have any additional comments or questions? (Optional)
Submit
Should be Empty: