New Client Form

Thank you for reaching out - as a reminder, our service moved to Home Euthanasia only as of Jan. 1st 2025. If you are looking for wellness services, we wish you all the best. If you are here for home euthanasia, please know how sorry we are & if you fill out the following we will get back to you as soon as possible. Thank you, the Wildflower team

* Indicates required field

Name *

First

Last

Phone Number *

Email *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Preferred Appointment Date or Time (if you don't know yet, just put that so we can be as helpful as possible) *

Pet Name(s) *

Breed/Species *

Sex/Status *

Pet Age/Birthday(s): *

Approximate Weight *

Reason for visit (please clarify if this is a consult/hospice visit or home euthanasia visit) *

Previous Medical History: *

Current Medications: *

Upload File *

Max file size: 20MB

Anything else you want us to know prior to your appointment? *

Thank you! We will get back to you as soon as possible!

Submit

Quick Links:

Appointment request:

Hospice Consult Request

Home Euthanasia Request

email for questions:

Email Link

Appointments are seen evenings and weekends.

Emails are answered or returned during normal business hours when we are not in other appointments. Please provide as much information as possible to help us serve you in a more timely manner.

Know that we are thinking of you and your family during this tough time. There is no good way to say goodbye, but being able to be together in the comfort of your own home is one of the sweetest gifts. We are glad to help with any questions you may have.

Thank you for letting us help walk these last few steps with you and your family - Dr. Desiree & the Wildflower team