705-309-2956 info@heartwithwings.net

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End of Life Care Form

We’re here to help you and your pets through what we know is a difficult and heartbreaking time in your lives.

APPOINTMENT

End of Life Care Form

Please complete the form below to request an appointment.

Pet Parent - Please use the same name you use at your vet's office *

First

Last

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Is this a condo/apartment? *

Yes
No

Is this your mailing address?

Yes
No

Mailing Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

What other family members will be involved in your pet's appointment?

Instructions: cross streets, house color, cars, etc. that will help us find your home

Phone Number *

Receive texts at above number? *

YES
NO

Email *

Have you used our services before? *

Yes
No

Who is your pet's veterinarian? *

Veterinary Clinic Name *

What dates and times are you considering for your appointment?

Pet Information

Patient Name *

Pet's Date of Birth *

Exact date of birth or estimated date of birth? *

Exact
Estimated

Sex *

Male
Female

Is your pet spayed or neutered? *

Yes
No

Species

Cat
Dog

Breed *

Weight *

Enter weight in pounds.

Color *

How may we help you? *

Senior Assessment
Quality of Life Discussion
Palliative Care Consultation and Treatment Plan
Virtual Consultation (Zoom)
Telemedicine Consultation
Email Consultation
Euthanasia

Tell us a little about your pet's issue. *

Is your pet currently on any medications and/or supplements (including CBD)? *

Do we have your authorization to post a memorial about your pet? Your pet's first name and an included photo would be the only identifier. *

Yes
No

If you would like, please upload a photo of your pet.

Drag & Drop Files, Choose Files to Upload

How did you hear about us?

If "other," please explain:

If you were referred, please let us know who sent you so we can thank them!

Has your pet bitten (and broken skin) on a person in the last 10 days? *

YES, my pet has bitten.
NO, my pet has not bitten anyone in the last 10 days.

May we help you with aftercare for your pet? *

Communal (no ashes returned to you)
Private (ashes returned)
Home burial/managing my pet’s aftercare. Cremation services are not required

If your pet is 35-90 pounds, do you have one person who can safely help lift your pet on a stretcher? If your pet is over 90 pounds, do you have two people who can safely help lift your pet on a stretcher? (We may be able to provide an extra person with enough notice.) *

Yes
No
My pet weighs less than 35 pounds.

Email

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Pet Aquamation in Barrie, ON and beyond

Heart With Wings provides aquamation services for pets and owners in Barrie, Orillia, Innisfil, the Georgian Bay Region, Cottage Country, and the surrounding areas.

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Hours of Operation

Mon-Wed: 8:00 am - 5:00 pm
Thur-Fri: 8:00 am - 6:00 pm
Sat: 8:00 am - 1:00 pm

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Contact Information

Phone: 705-309-2956
Email: info@heartwithwings.net

Please note: Phone and email response times may vary. Your call or email is very important to us, and we will contact you as soon as possible.

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We Are Here To Help

Request an appointment online in minutes from any device. We’ll get back to you as soon as possible to confirm your appointment.

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Have a question?

Complete the form below and we’ll be in touch with you shortly.

Name *

First

Last

Email *

Phone

How can we help you? *

Solve *

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