BRIDGE VISIT

BRIDGE VISIT

At-Home Euthanasia
Privacy Consent
Thank you for choosing Greenwood Veterinary House Call Services for your cherished companion’s care. This form helps us prepare for your upcoming appointment and ensure we provide compassionate and personalized support during this difficult time. By taking the time to plan ahead, you help us create a calm and seamless experience for both you and your pet.

Before completing this form, we encourage you to review our service fees and policies here. If you have any questions or financial concerns, please don’t hesitate to reach out—we’re happy to discuss options with you.

*Indicates a required question
Greenwood Veterinary House Call Services has a personal information policy in accordance with the requirements of the Personal Information and Electronic Documents Act. The information you provide in this form is essential for us to offer personalized and compassionate care for your pet. It helps us maintain accurate records, coordinate services, and ensure seamless support. This may include sharing relevant details with trusted third parties, such as other veterinary facilities or insurance providers, to support your pet’s care. We are committed to respecting your privacy and will never use or disclose this information for purposes beyond those outlined here, except with your consent or where required by law. Please confirm your consent below:*

I consent
Today's Date*

MonthDayYear
Date
Your Information
Your Email*
example@example.com
Your Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityProvince

Postal Code
Preferred Phone Number
Please enter a valid phone number.
Household Information
What other people may be present for the euthanasia? This may include your spouse/partner, child, friend, etc. Please provide their first name and relation to you (ex. John - spouse)
Are there children in the household? If yes, please provide their ages so we can share supportive resources to help guide them through their loss.*
Your Pet's Information
Pet's Name*
Species*
Breed*
Colour*
Gender*
Age or Birthdate*
Approximate body weight (please note if using pounds or kilograms)*
Has your pet shown signs of anxiety or aggression with strangers or during vet visits? Before we arrive, we want to ensure that your pet is as comfortable as possible during our visit. Based on your response, a team member may reach out to you to discuss ways to keep your pet comfortable during our visit, which may include discussing the use of pre-visit medication to help your pet relax.*
0 = no anxiety/aggression 5 = very anxious/aggressive
Who is your pet's primary veterinarian/veterinary practice?*
If you were not referred by your regular veterinarian for in-home euthanasia please tell us who referred you or how you found us.
Do you have pet insurance coverage?*

YesNo

Pet Insurance

If you would like us to bring a signed claim form at the time of your appointment, please provide the following information.
Pet Insurance Company
Policy Number

Urn Selection

When you request a Private cremation for your pet, it provides you with the opportunity to keep your pet’s cremated remains as a permanent and personal keepsake. Your pet’s cremated remains will be returned to your regular veterinary practice (typically in 1-2 weeks) in your selected urn, along with a certificate of cremation, authenticating that your pet was cremated at Gateway Pet Memorial. You may choose one of the five complementary urns that are provided at no additional fee, or choose from one of the many custom urns that can be ordered. Please take some time to review your options at www.gatewaypetmemorial.com. The complimentary urns are pictured below.
Complimentary Urns (include engraved/etched name at no additional fee on all urns except Scattering Tube).
*Please note, due to supply chain difficulties, some items may not be available in some sizes*
If you would like one of the complimentary urns picture above, which would you prefer?

Blue Scattering TubeCedar Memorial UrnDecorative Metal Urn - BlueDecorative Metal Urn - TanCarved Wood Urn
Would you like your pet's name engraved on the urn at no additional charge? (Please note this option is not available for the Scattering Tube)

Yes please.No thank you.
If you would like to order a custom urn, custom personalization, or an additional memorial item (personalized paw print, photo frame, jewelry, etc.) please specify here, including the description and product number noted in the catalogue. https://www.gatewaypetmemorial.com/memorial-products-ontario/ Please note that some custom products may have a longer delivery time.

Memorial Clay Paw Print
When you choose to have us coordinate aftercare on your behalf (either communal cremation or private cremation), we offer a complementary Memorial Clay Paw Print created by the crematorium. This item will be returned to your regular veterinary practice, typically in 1-2 weeks. Would you like a Memorial Clay Paw Print?

Yes, I would like a Memorial Clay Paw Print (no charge)No thank you, I do not wish a Memorial Clay Paw PrintYes, I would like a complementary Memorial Clay Paw Print, AND I would also like to purchase an additional Memorial Clay Paw Print ($70 ea + HST). To request other types of clay prints, please specify in the previous section.

Helpful Tips

The items below are provided to help ensure the appointment goes as smoothly as possible.
Prior to the appointment:*

Ensure that a parking spot is available as close to the home as possible to facilitate your pet's transportation to the doctor's vehicle.If your pet is still mobile, try to encourage them to go to the bathroom prior to the doctor's arrival. This will help to keep them as comfortable as possible.If your pet is still interested in eating, please feel free to offer special treats in the couple hours leading up to the scheduled appointment.Choose a location where you and your pet will be most comfortable, that also provides enough space for everyone to gather.Consider any items that you want your pet to travel with (a favourite toy, picture, or letter), and have them prepared and ready.
When the doctor arrives:*

Consider turning off phone ringers to avoid unwanted interruptions.Following the sedative injection, the doctor will remove themselves from the immediate area to provide time for your family to gather around, pet, and snuggle your pet.Crying during the appointment is normal. Please ensure you have lots of tissue and hand sanitizer available.If you have chosen to have us coordinate your pet's aftercare, your pet will need to be carried to the doctor's vehicle following euthanasia. If your pet weighs more than 25lbs, a family member will be asked to help (or two family members can carry your pet together). If this poses any challenges (eg. physical limitations), please be sure to discuss this with our team ahead of time.
Should be Empty:

BRIDGE VISIT

Privacy Consent

Your Information

Household Information

Your Pet's Information

Pet Insurance

Medical Information

Preparation

Euthanasia Consent

Aftercare Preferences

Urn Selection

Memorial Clay Paw Print

Helpful Tips