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Dignity Home Euthanasia Vets Form
Dignity Home Euthanasia Vets Form
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*
" indicates required fields
Step
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URL
This field is for validation purposes and should be left unchanged.
What is the name of your Vet Practice/Company?
*
Please note how you enter the details is how they will be entered into our system.
What's the best phone number to contact you on?
*
Thank you, what is the pets name?
*
Please note how you enter the details is how they will be entered into our system.
And their surname?
*
Please confirm their species.
*
Cat
Dog
Rabbit
Guinea Pig
Hamster
Chicken
Budgie
Parrot
Chinchilla
Snake
Ferret
Hedgehog
Lizard
Bearded Dragon
Rat
Degu
Tortoise
Fish
Other
When is the Home Euthanasia taking place?
DD slash MM slash YYYY
What time?
Hours
:
Minutes
How would the pet's owner like their pet to be transported to Dignity?
Pet owner to bring pet to Dignity themselves - please contact owner to arrange bringing in
Dignity to collect from the pet owner's home
Dignity to collect from Vet
Vet to transport the pet to Dignity
They can choose to bring the pet to us themselves, we can collect from their home after euthanasia, we can collect from you or you can bring the pet to us and charge your own fee.
When will you be bringing the pet to us?
DD slash MM slash YYYY
What time?
Hours
:
Minutes
Are they male or female?
*
Male
Female
Please confirm their colour.
*
Please confirm their breed.
*
Please confirm their approximate weight in kg
*
If known, what is their microchip number?
Will the pet have any items or bedding with them?
Yes
No
Please describe the item(s) below e.g. blue collar.
Is the pet considered to be contagious?
Yes
No
Please describe below and include any details about treatment given.
Please confirm the pet owner's full name.
*
And their title.
*
Mr
Mrs
Miss
Ms
Dr
Other
Please confirm the first line of the pet owner's address.
*
And their postcode.
*
Pet owner's email address
Pet owner's phone number
*
Do you have any additional information you need to tell us?
For example, Client not to be called when pet is collected, contagious disease identified, etc.
What's your name?
*
Please confirm your email address.
*
We need this to send you a confirmation email.
