Ark Angel Vet Appointment Form

Thank you for trusting Dr. Patrick with this important farewell.

This form takes about 5 minutes to complete and helps us prepare a gentle, personalised experience for you, your family, and your beloved pet.

A fee summary will be sent to you before any commitment is made but please reach out if you have any questions.

My Pet’s Details
My Pet’s Name
Breed & Colour
Sex
Age
Body Weight
in kg
My Pet’s Microchip (MC)
Pet's Microchip Number (If known)
Enter the microchip number here after selecting Microchip Number.

Vet Clinic
My Pet’s Regular Veterinary Practice (Please Include the Branch Location).
You can add any recent specialty centre or emergency hospital visits.
Primary Vets Name
You can add any recent specialty centre or emergency hospital visits.

Appointment Preferences

The Fees below are presented as a guide only, you will recieve a fee summary based on your choice of options prior to the booking.
Please select from the options below ❤
Please note, costs above include Vet Attendance and Euthanasia Process. Travel and Pet Transfer where required are additional.

Procedural Euthanasia is a brief appointment and generally does not allow time for grieving. We strongly recommend opting for the Perfect Googdbye for an unhurried process.

For more information please see our website.

Preferred Appointment Day and Time

I will contact you re an appointment time as close as possible to your requested time
Preferred Appointment Time
If you are not able to find your ideal time, please fill in your day and time in this box.

Dr Patrick will contact you to confirm your appointment time.
Requested Appointment Time - Alternate

Your Details
Name

PrefixFirst NameLast Name
Phone number
Email
My Address
Please include any details on the best place to park, etc.
Who will be attending the appointment (First Names)
Include children’s first names and ages. Include family members not attending so I can add them to my Condolence Card.
How did you find out about us?
If it was a personal referral please let us know who so that we may pass on our thanks.

Payment Preferences

Pre-Payment is preferred and appreciated.
Submitting this form is non-binding. Your fee will be calculated based on your selections, and a fee summary will be sent for your approval.

Fees are based on:

1. The type of appointment and the day you choose.

2. Travel to your home.

3. Transfer of your pet to a cremation facility (if required).
Your Payment Preference
Are You Claiming the Euthanasia Fees from Pet Insurance
The Name of your Pet's Insurance Provider is:
Questions, Concerns, and Special Requests
Please let me know if you have any particular requests or concerns.
Euthanasia Consent

I consent to the euthanasia of my pet to be performed by Dr Patrick Africano. I also understand that Dr Patrick may use audio recording during the visit to assist in completing the medical record. Please submit your consent by clicking the button below
If this will not submit, please make sure all required fields * are completed. If anything is missing, it will appear in a red box, please complete it so I can process your form without delay.
Should be Empty:

Medical Background