Dignity Home Euthanasia Vets Form

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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

Please describe the item(s) below e.g. blue collar.

Is the pet considered to be contagious?

Yes

Please describe below and include any details about treatment given.

Please confirm the pet owner's full name.*

And their title.*

Mrs

Miss

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.

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Dignity Home Euthanasia Vets Form

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