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Title
Name
Phone Number
Address
Email
Pet's Name
Species
Dog
Cat
Other
Breed
Age or DoB
Gender
Male Neutered
Female Neutered
Male Entire
Female Entire
Health conditions/severe symptoms
What medications is your pet taking, please include dose and frequency
Behavioural Issues e.g. aggression or anxiety
Registered Vets Name
Registered Vets Number
Are you the sole owner?
Is everyone involved comfortable with the decision to euthanise?
How urgently do you require an appointment
Same Day
Within 48 hours
Within the week
Within the month
Just planning ahead- time frame unknown
Estimated Weight
Location for appointment, if different to your home address
Do you have any concerns about the appointment?
What aftercare options would you like?
I will arrange my own aftercare (home burial/private crematorium arrangements)
General cremation (no ashes returned)
Individually cremated (ashes returned)
Casket/Urn Choice
Will anyone be able to help me lift your pet into the car? ((for any animal over 10kg we will require one helper/10kg).
Roughly how many people will be in attendance
Will any children be present?
Will any other pets be present?
How did you hear about us?
Vet Recommendation
Friend Recommendation
Social Media
Newspaper/Magazine
Other
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