I apologize that I am currently closed as i focus on personal health and healing. Please check back in November 2018

Meanwhile, please do not send the Question Form or emails regarding appointments until rechecking for my availability. 

Please see alternative housecall veterinarians under my Home page 

 

Question Form (please do not fill this out until I update that I am restarting my housecall practice, as explained above). 

 

If this is an initial enquiry regarding a Peaceful Home Euthanasia, please fill the form out (below)  as best you can, prior to our talk by phone or by further email. You do not need to feel commited to an appointment or preferred  arrangements until we reserve a specific time.  Your  information will allow us to use our communication time (phone or email)  to address your more specific questions regarding your considerations and your special pet. 

 

A quality of life exam is needed as a seperate appointment, if there are any doubts as to planning a peaceful home euthanasia appointment.  I cannot properly assess a pet or help you decide over the phone or email, without a pet exam and reviewing your pet's previous history/records. If there are any doubts (from you or any persons who are involved, or myself), please use the more general "Contact Form" under the "Contact Us" section,  in order to enquire about  first arranging a "Quality of Life" home appt. 

 

If you,  and those involved, are decided on the clear, kind  reasons for you and Dr. Susan to arrange a peaceful home euthanasia, please fill out the question form as best as you can, below. This information will allow both yourself & Dr. Susan to discuss any remaining questions/concerns, and prepare for a Peaceful Home Euthanasia appointment. 

 

To complete this form, please either copy this document (eg  into an email to then fill it out and send it back), or,  print it out to fill out and scan back as an attachment, or, fill out and fax it to us.

(If you are unable to scan/fax, please type an email answering the questions, thank you!)

 

***Please do not send enquiry forms or emails until re-checking for availability in December 2017***

email: ccvhs1@gmail.com  

or  Fax: 604-940-8808 (9am - 9pm only please)

 

Form for enquiry about a Peaceful Home Euthanasia Appointment: 

whether for answering more specific questions,or, for later allowing your pet to be the focus of my time in your home.  Please answer each question with a word or a line in CAPITALS, (as my printer is ONLY Black/white) . Please  email or fax it back to me, as above:

 

Part 1: You & Your Home

 

1. Your full name:

    Are you the legal owner, with the authority to sign legal and financial forms:

2. First and last names of your spouse or another family member who may be responsible for signing legal forms:

3. Address (include postal code):

4. Phone Numbers:

    Do you readily use text? If so please specify which number is preferred for text:

(Eg: I will call or text you as I am on my way to your home)

5. Email Addresses:

6. Who will be present? (Please let me know the names of others who will be present, and if family members have different last names than your own):

 

7. Will those initially present be staying for the whole procedure?  This is a very personal decision, which you may decide now or later. 

 

8. Will there be children present (young, teen, or adult)? 

(If so, please discuss this with me ahead of time as I have recommendations based on my experiences) Everyone who is staying needs to be 100% in agreement and support of your decision in order for me to proceed.Please double check with all involved, especially any adult children in the family.  If there is any doubt with anyone who would  be present, my protocol is to have  a "quality of life" consultation first, either with your clinic veterinarian or through me as a home visit - what ever is best for you and your pet - before planning a seperate day for a planned, peaceful, home euthanasia. Quality of life exams are not routinely performed on the same day as a peaceful home euthanasia, for reasons explained under "Quality of Life" exams. 

 

Is a "Quality of Life" consultation at home needed or possibly needed before planning a seperate "Peaceful Home Euthanasia" appointment? : 

 

Is everyone who will be present in support/agreement of your decision?

Please give names and ages of children including adult children: 

  

 

9. Parking:  I will need to park near your door, and in a secure parking area if your housing complex has one.  If it is busy street parking or paid street parking, please allow me to park in your parking stall. Please advise me of any additional parking costs  to be added to the invoice .

 

NOTE:If your home or house number cannot quickly be seen from the road when driving past,or in the dark,  or if you are in a rural area with a long driveway, please put a marker at the end of your driveway.  Ie: a recycling bin, chair, cone, potted plant –let me know what it will be -  so that I can easily identify your home - and advise me what to look for. If parking in your driveway, please allow for me to back in easily and please be prepared to come out and help me park if narrow or dark. Thank you very much for giving this some thought so we dont spend our home or phone time with parking logistics.

 

10. Please describe the parking arrangements:

11. Driving tips for your area, recognizing your home etc. (hedge, gate, trees)

 

12. Please let us know if you have any specifice considerations regarding scheduling (work, family, if day time or eve/saturdays better, occassionally I can help on Sundays, see further below re large dog considerations). 

 

 

 

 

Part 2 – Your Pet

 

1. Your Pet’s:         

                Name: (formal and common name if applicable):

                Age:

                Breed:

                Gender:

                Weight (for sedation purposes):

                Is this weight from a vet clinic or an approximate?

                What are your pet's medical conditions, or quality of life considerations, that are part of this decision?

 

2. Previous Veterinary Clinic(s) from the past 5 years:

(I will notify them of my visit the next day)

 

I understand that Dr. Hetherington may contact my previous veterinarian to review my pet's medical history in preparation of her visit.

 

3. What is your pet’s temperament?

  • How is your pet with visitors?

  • Would your pet let me pet them?

IF NOT, it is very important that we discuss this prior to my visit.  My goal is for this to be a very peaceful visit.  I will Possibly need to organize additional steps, extra time, sedation etc. if I feel that this is needed. it is much better to tailor our plans to best suit your pet. 

Please provide any details that I may need to consider this:

 

4. Do you have a Veterinary Insurance Policy?  

    If so, please have a insurance claim form,  signed and  prepared for Dr. Susan to take with her. This will be faxed for you with a paid reciept in the week following. Please contact me if any delay in the reply from the insurance company.

 

 

Part 3 – After Care Wishes

 

1. Would you like me to take care of all of the after care arrangements for you (to arrange with Until We Meet Again, as explained in the overview)?:

2. If Yes,

  • Do you request a Regular Cremation, where the ashes are NOT returned?:

  • Do you request a Private Cremation, where the ashes ARE returned?:

 

3. For Private Cremation Only:

  • Please write out the Urn Colour you would prefer (included in the cost):

                White

                Black

                Mother of Pearl

                Organza Pouch (no urn), if you would prefer to spread the ashes

  • Please advise me if you would prefer a special order urn (additional cost) from the  www.untilwemeetagain.ca. If so, please give me a full description of the urn, includng costs, after asking UWMAgain if it is available, and, if selected, I can add this to the invoice on your behalf. Special Order Urn Description:

 

  • Please type how would you like the names of your pet & yourself  to read on the certificate, which is returned with Private Cremations:

  • Your pets name: 

  • Name of yourself or family, eg Mary Smith,  or The Smith Family , or Greg Smith and Mary White, should include a last name : please write out your choice: 

  • There are 3  options as to having your pets ashes returned to you: 

    • Your veterinary clinic or a clinic nearby (clinics will kindly do this as a complementary service, and i will fax them) 

    • Your home depending (on where you live and if you can be home usually middle of the day for 2-3 hour window)

    • Directly at  Until We Meet Again (North Vancouver) - their centre is very peaceful and supportive, people find great solace in collecting thier pet's ashes there, highly recommended. Open weekdays and Saturday, Sunday.

 

  • Please state your preference for having your pets ashes returned: 

  • Please state the clinic name/location if you will collect ashes and/or pawprint from a clinic:

 

4. For dogs over 35lbs, I will need someone who is physically and emotionally able to assist me in carrying a stretcher. If your pet is over 50lbs, I will need a strong person to assist me who has no back problems or disability issues (family member, neighbor, friend).

Please let me know what you have arranged:

 

5. Would you like a Memorial Paw Print Casting? (please provide an answer of yes, no or unsure) 

 

This can be done before either a private or a general  cremation.

If you would like a Paw Print, please let me know and fill out the form ahead of time as best you can (form is in the drop down menu above "Spawts Paw Print Keepsakes").  If you need assistance, I can help you to finish filling out the form when I arrive, but please decide on colours etc before i arrive. If you plan to make your own pawprint, please advise me as I also have suggestions. 

 

 

 An official brief form and the Payment are completed when I first arrive.

Please review the "costs" section of the "Peaceful Home Euthanasia" section, and send me any questions regarding costs, to clarify by phone and /or email,  before I arrive. There are 3 costs: the housecall (evening or daytime?), the sedation and peaceful euthanaisa, and the cremation options (plus add'l paw print option if chosen). 

 

Please confirm your understanding of any additional  costs for assistance  involving: additional help needed, large dogs over 100 lbs/giant breeds,or agressive pets, and outline your understanding of the additional planning/timing  considerations as to your pets size and/or temperment (this will help us to focus on any areas we need to further clarify or organize):  

 

 

Would you prefer to use cash, Visa, MasterCard, or AmEx?:

 

How did you hear about our services?

 

Are there any other questions, concerns, or special considerations you would like to discuss or let me know about?: 

 

Regarding an appointment: Are there Preferred days, time? Timeliness?: 

 

Note: Signs of when more urgency needed, to help your pet within 24-48 hrs, or sooner, are : increased breathing OUT effort (pushing in with abdomen), coughing up phlegm, frequent coughing, respiration rate over 30/min, bloated appearance, pale gums (should be bubble gum pink), cant stand up, seizures, increasing inability to get up, especially if a large dog. If i cannot  contact you or help within this period, please arrange for help via one of the emergency clinics listed on this website 

 

I routinely would like to "meet" you on the phone after receiving this information to address your specific questions/considerations. Are there preferred days/times/numbers to contact you?

 

Please also contact me after sending this, if you have not heard back within 24-48 hrs, depending on the timeliness. I appreciate that you are looking ahead to help your pet this way as a great kindness. 

 

Sincerely, 

 

Dr. Susan Hetherington

Creature Comforts Veterinary Home Services Ltd.

 

© 2014 by Housecall Vet. All rights reserved.

Website by www.Suite-Apps.com

Creature Comforts Veterinary Home Services Ltd. is registered with CVBC, The Province of BC and Delta Corp.