Name *

First

Last

Address *

Address Line 1

City

State / Province / Region

Postal Code

Mobile Number *

Secondary Number

Email *

Pet's Name *

Breed *

Date of Birth *

Colour *

Approximate Weight *

Pet's Gender *

Is Your Pet Neutered/Spayed *

Current Vet Clinic

Consent for Request for Pet Records (copy)

I give consent for York Mobile Veterinary Services to request for my pet's records

I am looking for End of LIfe Care Appointment *

Within 24-48hrs
Within 1 week
Within 2 weeks
I am not ready to book the end of life appointment but would like to book a Consultation for Comfort Care/End of Life because I am unsure of timing

After Care Decisions *

I would like my pet privately cremated in his/her own chamber and cremains to be returned to me
I would like my pet cremated with other pets and understand that his/her cremains will not be returned
Undecided

I would like a Paw Print (made by Gateway Pet Memorial) *

Reason for Appointment

How did you hear about us?

If you chose referral, who can we thank?

Accept Terms *

We accept payment via e-transfer or credit card. Communication with us can be done through phone calls, emails or text messaging. When you submit this form, you are consenting to receiving text messaging. Please let us know if you would like to opt out of text messaging.

End-of-Life Registration Form

Book an Appointment Today!