End of Life Home Visit Request

End of Life Home Visit Request
I know this form may feel hard to fill out. Just reaching this point can bring up a lot of emotion, and that’s so normal.

These questions are here to help me understand your pet’s story and what matters most to you. They allow me to prepare for our visit with care, so I can bring the calm, comfort and support that your pet and your family deserve.

You don’t have to carry this alone. I’ll be with you through each step of the journey.

This form usually takes around 20 minutes to complete.

About You

Let's start with a few details about you.
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Have you ever supported a pet through end-of-life care? *
If you feel comfortable, I’d be grateful to hear about your experience, both the good and the hard parts, so I can understand and support you in the best way possible.

About Your Pet

Help me understand who your pet is and the life you're shared together
Pet's name*
Species*
Dog, cat, etc
Breed*
Date of birth or age*
Sex*
Colours/markings*
Approximate weight*
How long have they been part of your family?*

Medical Background

This section helps me understand your pet's health and any care they've received.
Has your pet seen any vets in the past 3 years? Please list which clinics and veterinarians you have taken your pet to in the last 3 years.*
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.
What medications or therapies are they currently receiving?*
This might include prescription medicines, over-the-counter products, joint supplements, herbal remedies, special diets, acupuncture, hydrotherapy, massage, or any other treatments.

How Things Are Going Right Now

This section helps me 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 me 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.

How Can I Support You

This section helps me understand what has brought you here and how I 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.
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.
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.

Communication & Support
How did you hear about Comfy Critters Home Vet?*
eg. Google search, referral, vet clinic, social media, friends/family, etc
What time of day is best for a follow-up call?*
Is there anything else you would like us to know about your pet, your family or what you're going through right now?*
Should be Empty:

End of Life Home Visit Request

About You

About Your Pet

Medical Background

How Things Are Going Right Now

How Can I Support You

Communication & Support