Hospice + End of Life Care Name * First Name Last Name Email * Phone (###) ### #### Home Address *if services will be in home Pet's Name Species/Breed Age Gender Male Female Tell us about their personality Current Diagnosis/Condition Veterinarian’s Name & Contact Info: Has your pet been given a prognosis or life expectancy? Is your pet currently in pain or discomfort? Yes No Medications or treatments currently being used: Mobility level (can they walk, get up, go outside, etc.): Has your vet discussed hospice or palliative care options? What concerns or fears do you have at this time? What kind of support are you seeking from a pet doula? Emotional support Help understanding options Guidance through the dying process Ceremony or ritual planning Practical help (comfort care, memorial ideas, etc.) Post-loss grief support Have you made any decisions about euthanasia or natural passing? Still considering Planning euthanasia Hoping for natural passing Do you want to create a memorial or legacy project? Yes No Unsure Have aftercare arrangements been made (burial, cremation, etc.)? Would you like help finding services or resources? Yes No Would you like grief support or check-ins afterward? Yes No Is there anything else you would like to share about your pet, your needs, or your wishes during this time? How would you like me to support you emotionally? Calming presence Space Holding Guided meditations Silence Talking things through Other Thank you!
