Client Registration Form

How did you hear about us? Which in-home service are you enquiring about? Palliative consultEuthanasia
Date/time you would like the appointment: Client name/Partner name or any other family members you would like to include: Address/Postal Code: Primary Phone number: Alternative Phone Number: e-mail: Regular veterinarian: Does your pet have health insurance: YesNo
Pet Name: Dog or cat: Cat Dog
Breed: Colour: Age: Sex: MaleFemale
Spayed/neutered: Yes No
Weight [kg]: After care wishes should your pet be euthanized:
Home burial
Group Cremation with no ash return
Semi Private Cremation with ash return
Private Cremation with ash return

A few words about what has been going on with your pet:

If you do not receive a response within 24 hours, it means we did not receive your message, please call 613-323-3000