Grooming Admission Form - Norbeck Animal Clinic

Grooming Admission Form - Norbeck Animal Clinic

Grooming Admission Form Date: ____________________________ Owner’s Name: _____________________________________________ Best contact phone today: ___...

NAN Sizes 0 Downloads 6 Views

Grooming Admission Form Date: ____________________________

Owner’s Name: _____________________________________________

Best contact phone today: __________________________ Pet’s Name: _____________________________

Alternate phone today: _____________________________

Breed: _______________________________________________

E-Mail Address: ______________________________________________________________________________ Special Grooming Instructions?: ______________________________________________________________________________ ____________________________________________________________________________________________________________ **Please note: For the protection of your pet and all other pets at Norbeck Animal Clinic, all vaccinations – including Bordetella (Kennel Cough) for dogs – must be current. We hope you understand the necessity of such requirements to protect all concerned. Permission to update vaccinations if not current: ________ Initials (Please call me before vaccinating: ) Do you want your pet to have a short Body Clip?

Or a Breed-Specific Trim?

Would you like an estimate today?: YES NO Estimated cost: $_______ **Please note: There is an additional charge for difficult dematting, to be determined by the groomer; also additional charges are necessary if your pet requires a Flea/Tick or Medical Bath/Dip If necessary, do we have permission to sedate at an additional charge?

YES

NO

Does your pet need to be seen by a veterinarian while here today? YES NO Details: _____________________________________________________________________________________ Does your pet have any other needs today (nail trim, anal gland expression)? YES NO Details: _____________________________________________________________________________________ If you cannot pick up your pet, we must have authorization to release your pet to another person before close of business. I authorize ________________________ (Name) at _______________________ (Phone#) to pick up my pet for me in my absence.

Signed___________________________________ Owner or Authorized Agent