What county do you live in? *

Hillsborough
Manatee
Pasco
Pinellas

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

Is this your mailing address?

Yes
No

Mailing 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

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
Other

Breed *

Weight *

Enter weight in pounds.

Color *

How may we help you?

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!

Has your pet bitten (and broken skin) on a person in the last 10 days? If so, euthanasia can not be performed unless the pet is tested for rabies afterward (fee $150). *

YES my pet has bitten and I agree to the fee for testing.
NO my pet has not bitten anyone in the last 10 days.

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)

Engraving: $25 for one line, $50 for 3 lines. Lines are limited to 26 characters including spaces. Please specify the message you'd like engraved in this box.

Brass nameplate: $30 for up to 3 lines. Lines are limited to 26 characters including spaces. Please specify the message you'd like on your nameplate in this box.

Request Appointment

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 Information