705-309-2956 info@heartwithwings.net

Facebook
Instagram

Facebook
Instagram

Home
Our Team
- Join Our Team
Hospice Center
End of Life Care
Our Services
Pricing
- Financial Assistance
- Henry and Friends Memorial Fund
Resources
Animal Loss & Grief Support Group
Contact

Select Page

New Client Palliative and Hospice Care Form

Please fill out this new client palliative and hospice care form as completely and accurately as possible so we can get to know you and your pets before your visit.

Get Started

We are here for you

New Client Palliative and Hospice Care Form

Please complete the form below to request an appointment.

Pet Parent - Please use the same name you use at your vet's office *

First

Last

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Is this a condo/apartment? *

Yes
No

Is this your mailing address?

Yes
No

What other family members will be involved in your pet's appointment?

Instructions: cross streets, house color, cars, etc. that will help us find your home

Phone Number *

Receive texts at above number? *

Yes
No

Email *

Have you used our services before? *

Yes
No

Who is your pet's veterinarian? *

Veterinary Clinic Name *

What dates and times are you considering for your appointment?

Date

Time

Pet Information

Patient Name *

Pet's Date of Birth *

Exact date of birth or estimated date of birth? *

Sex *

Male
Female

Is your pet spayed or neutered? *

Yes
No

Species

Cat
Dog

Breed *

Weight *

Enter weight in pounds.

Color *

Tell us a little about your pet's issue. *

Is your pet currently on any medications and/or supplements (including CBD)? *

How may we help you? *

Quality of Life Discussion
Palliative Care Consultation and Treatment Plan
Telemedicine Consultation

If you would like, please upload a photo of your pet.

Drag & Drop Files, Choose Files to Upload

How did you hear about us?

Family Member Friend/acquaintance
Coworker
Veterinarian
Pet Professional (groomer, pet sitter)
Local Business
Business Card
Display Online
Search Google Ad
Yelp Facebook/Social Media
Newspaper/Magazine
Other

If "other," please explain:

If you were referred, please let us know who sent you so we can thank them!

iconfinder_Untitled-1-17_6168888

In-home veterinary care in Barrie, ON and beyond!

Heart With Wings provides mobile veterinary services, including in-home hospice and palliative care, pet euthanasia, and aftercare for pets and owners in Barrie, Orillia, Innisfil, the Georgian Bay Region, Cottage Country, and the surrounding areas.

aaha



Hours of Operation

Mon-Wed: 8:00 am - 5:00 pm
Thur-Fri: 8:00 am - 6:00 pm
Sat: 8:00 am - 1:00 pm



Contact Information

Phone: 705-309-2956
Email: info@heartwithwings.net

Please note: Phone and email response times may vary. Your call or email is very important to us, and we will contact you as soon as possible.

Address: 4-680 Bayview Dr. Barrie, ON L4N 9A6

Areas of Service

Please call to discuss travel distance if it's outside of the map area.

Barrie
Orillia
Innisfil
The Georgian Bay Region
Cottage Country
The surrounding areas

iconfinder_cross_paw-vet-pet_5413362

We Are Here To Help

Request an appointment online in minutes from any device. We'll get back to you as soon as possible to confirm your appointment.

iconfinder_pin_marker_location-18_2873075

Have a question?

Complete the form below and we'll be in touch with you shortly.

Name *

First

Last

Pet Name *

Breed *

Age *

Weight *

Email *

Phone *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

How can we help you? *

Custom Captcha *

What is 1+20?

Message

© 2026 Heart With Wings | Powered by PetDesk