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Grooming Form

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Grooming Form

Client Information

Name *

First

Last

Phone *

Patient Information

Patient Name *

Species *

Breed

Weight

What type of grooming procedure is being done today? *

Are there any specific problems to address/be aware of or procedures to be performed during the grooming? *

I understand that a current rabies, distemper (and Bordetella for dogs) and canine influenza are required upon admission into Complete Animal Wellness and Longevity Medispa. *

I understand

I also understand that a current (within a calendar year) heartworm test and stool check for intestinal parasites must also be up to date. *

I understand

Is the pet UTD on required vaccines and annual exam? *

I understand that in the event fleas are noted on my pet, Complete Animal Wellness and Longevity Medispa will treat with appropriate parasite control medication while my pet is in the hospital, and I will be charged for the medication. *

I understand

Today's contact number for when pet is ready for pick-up *

EMERGENCIES: If the need for emergency care arises, I give my permission for such care to be administered as deemed necessary by the on-duty veterinarian at Complete Animal Wellness and Longevity Medispa. *

I DO give permission
I DO NOT give permission

Date *

Signature *

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Online Form

Grooming Form

Grooming Form

Client Information

Patient Information

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