Quality of Life Telehealth Request

Quality of Life Telehealth Request
About This Form

Thanks for reaching out. This form helps us learn more about your pet and what you're hoping for from a Quality of Life call.

Some families are looking for reassurance that their pet is doing okay, others want guidance about changes they've noticed, and some are just starting to think ahead and would like to talk it through.

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

This form will take approximately 15 minutes to complete.

Your Details

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

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Contact Number*
Please enter a valid phone number.
Email address*
example@example.com

About Your Pet

I'd love to know a little more about the pet you're booking for
Pet's name*
Species*
Breed*
Date of birth or age*
Sex*
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 vet clinic visits?*
Does your pet show fear, anxiety or stress with home visitors?*
Are there things that help them feel more relaxed or safe?*
eg. treats, toys, certain handling styles, quiet environments, specific people

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.

Past Vet Experiences & What You're Hoping For
How have things been with your previous vet care?*
Was there anything you appreciated or would prefer to do differently?
Are there any situations or treatments you do not want them to go through?*
This could include things like resuscitation, emergency vet visits, hospitalisation, aggressive treatments, or anything that might cause distress, panic, or unnecessary discomfort for your pet.
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 led you to book a Quality of Life call today?*
This helps me 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.
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 to talk through during this call?*
This helps me 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?*
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?*

Photo Permission
By completing this section, you give permission for Comfy Critters Home Vet to take and use photographs of you and/or your pet for educational, promotional, or awareness purposes. No payment or compensation will be provided for the use of these images. Thank you for allowing me to share the quiet beauty of this work.*

I consentI do not consent
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Quality of Life Telehealth Request

Your Details

About Your Pet

Your Pet's Personality & Comfort

Medical Background

How Things Are Going Right Now

Past Vet Experiences & What You're Hoping For

How Can I Support You

Communication & Support

Photo Permission