Your Details

First name

Last name

Phone

Address for Visit

Animal Details

Animal Name

Animal Age

Animal Species

Dog

Cat

Breed

Weight

Please detail any behaviour concerns

Please detail any health concerns

Regular Veterinarian

Would you be like me to inform your regular clinic of your pets passing via email?

Yes

Aftercare Options

Thinking about these options in advance will help to relieve any decision making on the day of your home visit. I will check at the home visit to confirm your wishes & we can discuss or make adjustments if needed. All options (except the Reterneti stone) have an expected turn around time of 1-2 weeks.

Aftercare Option

Home Burial

Cremation with Ashes Return

Cremation without Ashes Return

Aquamation

Optional Keepsakes

We include a few little routine keep sakes with your permission, please let us know what you would be comfortable with, (there is no additional charge for these, just a little memento if you wish).

Multi choice

Ink Paw Print

Ink Nose Print

Fur in small Glass Vial

We routinely do these keepsakes after the visit as it can be a little messy with Ink but you can elect to do them at the time of visit if you wish or you want your children to be involved.

Single choice

At Visit

After Visit

Pricing

The total cost of a home euthanasia will be a combination of the home visit we provide & the aftercare option you elect.

Home Visit

For the home visit the cost is inclusive of (sedation, home euthanasia Visit, aftercare transport, mileage within 10km our base (Sandhurst Road), optional keepsakes & GST)

Cats and Small dogs (1-10kg) $420
Medium dogs (11-26kg) $450
Large dogs (27-45kg) $480
Giant dogs (+45kg) $500

Aftercare

Aftercare Pricing; as per our local cremation company options Here

Invoicing

We will invoice for the combination of the home visit & aftercare option via email following the visit and forward the aftercare cost onto the cremation company pet farewells on your behalf.

If you have any questions, please let me know.

Would you like an itemised quote sent?

Yes

Consent

Consent: I certify that I am the owner or authorized agent of the owner, for the above-named animal. In being the owner/agent for this animal, I do hereby give 'A Gentle Goodbye' Veterinarian full and complete authority to perform humane euthanasia services. Arrangements for aftercare will be based on the wishes of the owner/agent and documented above.

I understand & Accept the payment terms above

Signature

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Please detail any questions or other information you wish to add.

Thanks for inquiring with our services, we will do our best to make the experience as stress-free and peaceful for your family and beloved pet.