ENQUIRY FORM

Loyal and Loved - Home Euthanasia and Palliative Care Vet

Have you seen Dr Raf before?

Reason for Enquiry:

What Suburb are you in? *

Postcode

Approximate Travel Time to Bondi Junction (minutes) *

Directions for parking

Your First Name *

Last Name

Phone *

Phone Number Match:

Please Re-enter phone number to make sure it is correct. We will text you soon to confirm.

Pets Name *

Pet Species *

Pets Gender *

Pet Breed *

Pets weight *

Pets Age *

Are you able to hold your Pet for Vet exam? *

How is your pet around new people? *

Are you the owner of this pet? *

Ownership History, how long have you had this Pet? *

How long since your Pet has seen a vet? *

Symptoms: *

Is your Pet taking any Medications? *

The following section will give you a quote for a peaceful passing at home. If you don't need that now you can skip these questions.

Would you like us to take care of cremation afterward?

If selecting cremation, would you like the ashes returned to you in a special Vessel (385)

Estimate for Callout, Consultation, medications and Peaceful Passing at Home

Estimate for Transport Cremation and Aftercare.

Combined Total: Peaceful Passing at Home and Aftercare

Would you like to give an address and apply for the next available booking time?

Yes please

Not yet

Preferred Booking time?

Please Submit and we will manually review the info, then reply message to help you further.