Booking Form | Rockmill Mobile Vet

First name

Last name

Email

Phone

Address

Is this an urgent request?

Yes

No

Pet's name and age

Pet species

Dog

Cat

Pet's breed

Is your pet male or female? Is he or she neutered or spayed?

Male

Female

Male neutered

Femal spayed

Weight of your pet

Is your pet aggressive or difficult to handle?

Yes

No

If you answered yes to the above question, please explain.

Brief explanation of why you are seeking in home euthanasia for your pet.

Is your pet current on rabies vaccine? Please provide the date of their last rabies vaccine.

Has your pet bitten anyone in the last 10 days?

**Rabies testing is required by law if your pet has bitten someone within 10 days of euthanasia.**

Please choose a cremation option from below:

No cremation - owner is responsible for body aftercare

Communal cremation - No ashes returned $150

Private cremation - Ashes returned with 1 paw print and lock of hair included. $300 for pets under 40 pounds, $350 for pets over 40 pounds.

Additional paw prints - please specify how many. Extra paw prints are $30 each.

How many additional paw prints would you like?

If you chose private cremation, please list what you would like the engraving to say:

Do you have any additional questions or concerns that you would like to have addressed by the veterinarian? If so, please explain.

Please tell us how you heard about us.

Please enter your name to acknowledge that you understand that the entire amount due needs to be paid prior to your appointment.