First and foremost, there has been a paradigm shift in human and companion animal relationship; from being pet owners to pet parents. This change along with other several secular trends, rising income, delayed parenthood, and rising awareness of treatment options has been positive for tertiary pet health care as well. So, in a sense pet health care is progressing towards and now more akin to pediatric care both in perceptions and expectations of pet parents. Furthermore, several factors such as inbreeding, environment/ pollution, poor nutrition/ diet, lack of active lifestyle required for healthy pets are contributing to increase in the number of cases that require tertiary care. These are wide ranging from bone deformities, skin, kidneys, lungs, cancer and cardiac ailments to name a few.