727-210-5517 info@hhphospice.com

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Dr. Buisson will be out of the country speaking at a conference Oct 12-19. She will be in Seattle speaking at a conference Oct 20-24. Appointments will be available starting at 10 am Oct 25. If you need assistance before then, please go to www.inhomepeteuthanasia.com to locate a veterinarian in your area. All correspondence will be returned by Oct 26. Thank you.

Request an appointment online!

Please complete the form and we’ll get back to you as quickly as possible to confirm your appointment. If this is an emergency situation, please call us at 727-210-5517.

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

Zip Code

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

Instructions - cross streets, house color, cars, etc that will help me find your home.

Phone Number *

Receive Texts at Above Number? *

YES
NO

Your E-mail address (please add info@hhphospice.com to your address book to avoid our emails going to SPAM.) *

Who is your pet's veterinarian? We send a report with each appointment *

Veterinary Clinic Name *

Do you have pet insurance? Hospice care and euthanasia may be covered under your policy. *

YES
NO

Pet Information

Patient Name *

Date of Birth *

Sex *

Male
Female

Is your pet spayed or neutered? *

YES
NO

Species

Cat
Dog
Other

Breed *

Weight *

Enter weight in pounds.

Color *

How may we help you?

Request phone consultation
Request email consultation
Request Hospice House Call
Request Euthanasian House Call
Other

Other Request

Tell us a little about your pet's issue *

If you would like, please upload a photo of your pet. Photos may be used with your pet's first name only on social media.

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!

If your pet weighs over 35 pounds, are you (or someone else) available to assist with moving him/her to the car on a stretcher? *

Yes
No
My pet is under 35 pounds.
My pet will not require transport.

If you are interested in cremation, do you prefer:

Communal (no ashes returned to you)
Private (ashes returned to your veterinarian)

If you want a private cremation, you may choose an urn ahead of time: (photos are below)

Tan Metal Urn
Blue Metal Urn
Remembrance Urn
Sheesham Urn
Cedar Latch Urn
Velvet Bag – No Urn

Comment

Tan Metal Urn

Blue Metal Urn

Remembrance Urn

Sheesham Urn

Cedar Latch Urn

Velvet Bag – No Urn

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