End of Life Home Visit Request

End of Life Home Visit Request
We know this form may feel hard to fill out. Just reaching this point can bring up a We know how hard it can be even to reach this point. Just being here means you're carrying a lot of love — and we're here to support you in whatever way we can.

This form helps us understand your pet's story and what matters most to you as you prepare for their final goodbye. It gives us the information we need to support you with gentleness and love- in the lead-up, on the day itself, and in the time that follows.

An End of Life Home Visit allows your pet to stay at home, curled up in their favourite spot, surrounded by familiar smells, soft blankets and all their loved ones. There's no rush, no bright lights or sterile spaces — just peace, presence and time to honour this moment together.

This is an unhurried in-home appointment. We'll take the time your pet deserves, and guide you gently through each step.

Once submitted, we’ll be in touch to talk through next steps and book your appointment.

This form usually takes around 10 minutes to complete.

Your Details

Let's start with a few contact details so we know how to reach you.
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Post Code
Phone Number*
Please enter a valid phone number.Format: 0000 000 000.
Email address*
example@example.com
What time of day is best for a follow-up call?*

About Your Pet

We'd love to know a little more about who your pet is and the life you've shared together.
Pet's name*
Species*
Dog, cat, etc
Breed*
Date of birth or age*
Sex*
Is your pet desexed?*

YesNo
Approximate weight (kg)*
Colours/markings*
How long have they been part of your family?*

Your Pet's Personality & Comfort
Does your pet show fear, anxiety or stress with visits to the vet clinic?*
Does your pet show fear, anxiety or stress with visitors at home?*
Are there things that help them feel more relaxed or safe with visitors at home?*

Medical Background

This section helps us understand your pet's health and any care they've received.
What conditions or diagnoses has your pet been living with?*
This could include any diagnoses from your vet, results from blood tests or scans, or ongoing health concerns. If your pet hasn’t had recent tests or visits but you’ve noticed changes at home, please include those too — everything you share helps me understand the bigger picture.
Has your pet seen a vet recently? Please list which clinics you have taken your pet to in the last 2 years.*
Is your pet currently on any medication, supplements or receiving any therapies?*
This might include prescription medicines, over-the-counter products, joint supplements, herbal remedies, special diets, physiotheraphy, hydrotherapy, acupuncture, or any other treatments.

How Things Are Going Right Now

This section helps us understand where things are at today.
How would you describe your pet's current health and wellbeing?*
Please share what life looks like for your pet at the moment. You might think about their daily comfort, energy, appetite, mobility, mood, sleep, or any changes you’ve noticed. There are no right or wrong answers - this is simply to help us understand your pet’s story as fully as possible.
Many pets don’t show pain in obvious ways. Sometimes it looks more like little changes in comfort or behaviour. Have you noticed anything that makes you wonder if things are harder for your pet now?*
Changes in comfort can be easy to miss, as pets often show them in subtle ways rather than obvious signs. You might notice things like slowing down on walks, stiffness, finding it harder to lie down or get up, changes in posture, reluctance with stairs or jumping, restlessness at night, panting when not hot, trembling, hiding, seeming less playful, or just appearing a little unsettled.
How is their appetite and thirst?*
For example, are they eating less or more than usual, seeming picky with food, losing interest in treats, drinking more water than normal, or needing encouragement to eat or drink?
How is their mobility? *
For example, are they slowing down on walks, finding stairs or jumping more difficult, slipping on floors, limping, stiff when getting up, difficulty with toileting, or tiring more quickly?
Are there any changes in their behaviour or mood you've noticed?*
For example, becoming more withdrawn, restless, anxious, clingy, pacing at night, seeming confused, changes in sleep, being less playful, hiding more, or showing signs of irritability.
Are there things your pet used to do easily that have become harder for them, or that they’re no longer able to do?*
This might include things like: going for walks, climbing stairs, playing with toys, eating or drinking easily, using the litter box or toilet outside, jumping onto the couch or bed, greeting you at the door, or getting comfortable when resting.
If you have supported a pet through end of life care before, would you feel comfortable sharing a little about that experience?*
We'd be grateful to hear anything you'd like to share - the good, the hard, or anything that stayed with you. It helps us understand where you're coming from, and how we can support you with care and sensitivity.

How Can I Support You

This section helps us understand what has brought you here and how we can best support you and your pet.
What prompted you to seek end of life care at this time?*
Families reach this point for many different reasons. You may feel your pet’s quality of life is declining, or that their good days are becoming fewer. You might be thinking ahead and wanting to make a plan, or simply recognising that the time to say goodbye is drawing near.
Do you have a timeframe in mind?
Let us know if you're hoping for a visit soon, within the week, or if you're just starting to think things through. This simply helps us understand your needs so we can do our best to support you at the right time.
What parts of this journey feel hardest or most uncertain right now?*
Many people feel uncertain, overwhelmed or frightened when facing the end of life. You might be worried about making the decision too soon, or leaving it too late. Some families feel anxious about their pet being in pain, not knowing what the final days will look like, or how they and their loved ones will cope.
When the time comes, what would you hope your pet’s farewell to be like?*
For some families, this might mean being at home in a favourite spot, surrounded by loved ones. Others picture soft music, a special blanket, or favourite food and treats. You may want plenty of quiet time, or to include children or other pets.
Will any other family members or friends be present during the visit? If you're comfortable sharing, can you include their names so I can greet everyone by name when I arrive.*
Have you thought about what you would like for your pet’s aftercare?*
Some families choose cremation, others prefer home burial, and some are not sure yet.
During your pet's end-of-life visit, I sometimes offer to gently capture a few quiet moments or details (eg hands, paws, fur, or time spent together) if, and only if, it feels appropriate and supportive on the day. These images or short video moments are intended first and foremost as a way to help you remember and honour this time, and will be shared with you digitally as a small keepsake if you wish. With your permission, and only if you are comfortable, some of this content may also be used for educational, awareness, or gentle promotional purposes (such as on my website or social media), to help other families understand what in-home end-of-life care can look like. There is no obligation to say yes, and you are always welcome to change your mind at any point.*

I consentI do not consent

Communication & Support
How did you hear about Comfy Critters Home Vet?*

Google searchVeterinary referralFriends/familyFacebookInstagramOther
We love thanking the people who share our name. If a friend, family member, or clinic referred you to us, who can we thank?
Is there anything else you would like us to know about your pet, your family or what you're going through right now?*
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End of Life Home Visit Request

Your Details

About Your Pet

Your Pet's Personality & Comfort

Medical Background

How Things Are Going Right Now

How Can I Support You

Communication & Support