Ark Ange Vet Submissons

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
My Pet’s Microchip (MC)
Body Weight
in kg
Pet's Microchip Number (If known)
Enter the microchip number here after selecting Microchip Number.

Vet Hospital

Also recent - Emergency and or Specialist Care
My Pet’s Regular Veterinary Practice (Please Include the Branch Location). ie Vet West - Yokine
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
* The prices listed above cover the Euthanasia process only. Travel fees and Pet Transfer services (where required) are additional and will be itemised in my Fee Summary Text.

* The Simply Goodbye Euthanasia Option (1/2 hr) is a brief appointment. Generally, it does not allow time to grieve or to review the Quality of Life discussion. I strongly recommend opting for the Perfect Goodbye for an unhurried process.

For more information, please see our website.
Second Pet Name
Second Pet Breed & Colour
Second Pet Body Weight
in kg
Second Pet Sex
Second Pet Microchip Number

Aftercare

The questions below will allow you to customise how your pets farewell takes place. This helps me prepare the setting that feels right for you, your family and your pet.. The Fees below are a guide only, I will send you a fee summary I based on your choice of options.
My Recommended Cremation and aftercare options
Other Cremation Companies, Evermore & Passing Paws
For more information on Aftercare please see more from the providers:

Ripple: https://rippleaquamation.com.au/
Lawnswood: https://lawnswood.com.au/

Please note: All cremation services are arranged directly with the crematorium. Cremation costs are separate and will be quoted by the selected cremation company.
Pet Transfer Options

If needed after our appointment, I can transfer your pet to your chosen facility.
Transfer Options
Other Transfer

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 Day & Time.

My 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 fee to your home.

3. Transfer by me, of your pet to a cremation facility (if required). Same day or Next Business Day.

Pre-payment is preferred so we can make our appointment focused on you, your family and your Pet.
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: