Quality of Life Phone Appointment Request

Quality of Life Phone Appointment Request
About This Form

We know that filling in a form like this can feel hard - especially when the future feels uncertain. Thank you for taking this step.

This form helps us get to know your pet and what you're hoping for from a Quality of Life Support Call.

Some families are looking for reassurance that their pet is doing okay. Others want help making sense of recent changes or diagnoses. And some are just beginning to think ahead and would like to talk it through with avet who understands end of life care.

This is a paid phone appointment with an experienced palliative care veterinarian, and it's a chance to gently explore what's going on and what kind of support might be most helpful.

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

This appointment request form will take approximately 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

Postal / Zip 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
Breed
Date of birth or age
Sex
Is your pet desexed?
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?
eg. treats, toys, certain handling styles, quiet environments, specific people

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 a quality of life support call at this time?
This helps us understand what you're hoping to talk through. Some people want to share changes they've noticed, otheres are seeking reassurance, and some just need a safe space to explore their thoughts and feelings about their pet's stage of life.
Do you have a timeframe in mind?
Let us know if you're hoping for a call 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 unsure, overwhelmed or scared, especially when making tough decisions. You might be worried about making the call too soon, about your pet being in pain or discomfort, not knowing what to expect, or how your family will cope.
What would you most like help with in this call?
This helps us focus on what matters most to you right now. Some people want to share changes they’ve noticed, others want to explore what the future might look like, and some are simply seeking reassurance and clarity.

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

Quality of Life Phone Appointment 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