In Your Home: Quality of Life Appointment Request

In Your Home: Quality of Life Appointment Request

(This appointment will take place in your home)
Full Owner's Name

First NameLast Name
Phone Number
Please enter a valid phone number that can receive text messages.Format: (000) 000-0000.
Email Address
example@example.com
Please confirm that the above phone number can receive text messages.
By checking, you are allowing Paws of Serenity LLC to send you informational texts and reminders about appointments and your pet's care. Message frequency may vary. Message and data rates may apply. Reply HELP for help or STOP to opt-out.
By checking, you accept Paws of Serenity's Terms of Service & Privacy Policy. (direct link below)
Terms, Conditions & Privacy Policy
Address for appointment

Street Address

Street Address Line 2

CityState

Zip Code
Any additional information about your address:
Please let us know here if you have a preferred door to enter. If you live in an apartment please list the best place to park and which door (north, west, etc.) to enter to get to your apartment or any other information that will help in getting to your home.
Pet's Name
This is for a single pet only, a separate form must be filled out for a second pet.
Species
canine or feline
Pet's Breed
Pet's Age
Pet's Gender
Pet's Weight (ok to estimate)
Is your pet up to date on Rabies vaccine (Paws of Serenity DOES see pets that are NOT up to date on Rabies vaccine?
Information for appointment
Day and time you would prefer to schedule:
Concerns about your pet that initiated you making this appointment:
What is your primary veterinary clinic?
For records request
Is there another owner's name that your pet might be under at their veterinary clinic?

First NameLast Name
Alternate phone number for additional owner:
Please enter a valid phone number.Format: (000) 000-0000.
If, during your Quality of Life Consultation, you and Dr. Haroldson determine that euthanasia is an appropriate option, would you like the possibility of proceeding with euthanasia during the same visit? (Selecting "Yes" does not mean you are committing to euthanasia. This information simply helps us prepare for your visit with the appropriate time allowance, medications, supplies, and aftercare arrangements if needed. Euthanasia and cremation services are not included in the consultation fee and would be additional costs.)
Pet Behavior for Safe Handling
Has pet shown signs of aggression? (Please note: Dr. Haroldson comes to these appointments alone - this means you will be holding your pet for the exam. If you are concerned about this we can discuss reaching out to your current veterinary clinic to get medications to help decrease anxiety in fearful situations. If you are unable to assist in holding your own pet Dr. Haroldson is not going to be able to see your pet at home.)
If yes, please elaborate on the situation so that we can attempt to make your appointment the most comfortable and least stressful for you and your pet.
If no, please put N/A
What happens next?

Once Paws of Serenity has received this form you will receive a text message to set up an appointment and receive an estimate - this estimate will be honored for 60 days. You will receive a link via text or an invoice will be emailed to you the day before or the day of your appointment. Payment is due at the beginning of the appointment. Paws of Serenity accepts payment via card through Cherry or Square and can also accept Cherry payment plans, cash or Venmo. Please text 701-353-0937 or email pawsofserenityvet@gmail.com with any questions or concerns.
Should be Empty:

In Your Home: Quality of Life Appointment Request

Information for appointment

Pet Behavior for Safe Handling

What happens next?