"*" indicates required fields

Client Information

Client Name

First

Last

Co-Owner Name

Address*

Street Address

Address Line 2

City

State

ZIP Code

Phone*

Email*

Pet Information

Pet's Name*

Species*

Cat

Dog

Breed*

Sex*

Male

Neutered Male

Female

Spayed Female

Has your pet ever had any allergies or bad reactions to foods, drugs, vaccines, topical treatments or other substances?*

Yes

If yes, please explain*

Does your pet have any medical or behavioral conditions that may be negatively affected by the bathing, clipping, use of dryer, or restraint required for grooming?*

Yes

If yes, please explain*

Has your pet ever bitten anyone?*

Yes

Does your pet have medical records at an out hospital?*

Yes

If yes, please share where*

Medical Requirements

For the protection of your pet, all pets being groomed are required to have the following medical
requirements:

Dogs Vaccinations – Rabies, Canine Distemper, Parvovirus, Bordetella, Influenza, and current negative fecal.

If my pet is not up to date on the above listed vaccine requirements at the time of my pets visit, then a
physical exam will be required by the attending veterinarian for my pet to be groomed, this will be done
at my expense.

If my pet is found to have any condition that may be able to spread to other pets, they will be required
to have an examination performed by an attending veterinarian to be determined if they are an
acceptable candidate for grooming. The exam and any treatment deemed necessary to address this
condition will be done at my expense, or I will be required to reschedule my pet’s grooming
appointment to a date after my pet is in compliance with our medical requirements.

If fleas are found on my pet, the pet will be treated with a flea/tick preventative and/or be administered
a flea bath in order to maintain sanitation within the hospital. This is done at discretion of professional
staff and at the client’s expense. Flea shampoos will kill the fleas on the pet. If fleas are in the home,
then the flea shampoo will not protect the pet once they leave the facility. We recommend year-round
protection using a comprehensive parasite prevention plan for your pet.

Pet Health and Behavior Statements

To my knowledge, my pet is fit and healthy for grooming. I have disclosed all known risks, dangers, and
medical conditions associated with my pet and have disclosed any preexisting conditions to the staff
and I release the groomer, hospital and all affiliated agents from any/all liability associated with the
worsening of an existing medical condition that results from grooming. I understand that senior pets
(age 7 or higher) may have a greater chance of injury or fatigue.

I MUST disclose if my pet bites, has bitten, or is aggressive to people, other pets or is known to be
intolerant of specific grooming procedures. Muzzles may be used if necessary to ensure the safety of
everyone including the animal being groomed. We reserve the right to refuse/stop services for such
pet(s) at any time before or during the grooming process. If my pet should bite or injure our staff and
your pet’s Rabies vaccination status is determined to not be current at the time of a bite my pet may
need to be impounded for the required quarantine period.

Sedation Policy

The majority of pets tolerate bathing and grooming without issue. Occasionally, however, a pet may be
too aggressive or too anxious to permit grooming without being a danger to itself or the staff. These
pets often require sedation in order to be safely groomed. If there appears to be any potential dangers, this appointment may need to be rescheduled with a safer plan in place created by our Fear Free Certified medical team. In the event of any emergency during grooming where there is no time to stop and reschedule: I authorize the attending veterinarian to administer sedation. I authorize the attending veterinarian to
administer sedation or anesthesia to my pet for safe grooming, if needed. In the event it is determined
that your pet will require sedation to be groomed at a time after check-in, we will make every effort to
contact you at the numbers you provided. If we cannot reach you, the grooming service will be
cancelled and rescheduled.

If sedation is performed additional costs will apply. I understand that some risks always exist with
sedation/anesthesia and that I am encouraged to discuss any concerns I have about those risks with
the attending veterinarian before the procedure(s) is/are initiated. I also understand that a physical
exam and pre-anesthetic blood work may be required prior to any sedation or anesthesia.

Initials for understanding Sedation Policy*

Mat Removal Policy

If my pet has fur that is severely tangled and/or matted, it is a greater risk of injury, stress, and trauma.
All precautions will be taken. However, problems occasionally arise, during or after grooming, such as
nicks, clipper irritation, and mental or physical stress associated with mat removal. I understand that
the de-matting procedure increases the risk of injury to my pet but its resolution is important to their
health and well-being and I will not hold the groomer, hospital and/or all affiliated agents liable for
injury or medical expenses resulting from my pet being de-matted. The de-matting process is time
consuming and additional grooming charges may apply. In addition, the mat removal process can be
painful and may require the use of sedation. If sedation is required, additional charges will apply (see
above section)

Emergency Care Plan

Grooming procedures can sometimes be stressful, especially for a senior pet or pet with health
problems and can expose hidden medical problems or may aggravate a current one during or after the
groom. I understand that there are inherent risks, such as illness or injury, when my pet is groomed. I
accept these risks because they are outweighed by the benefits. I authorize the provision of veterinary
care for my pet if it is deemed necessary and/or I cannot be reached. I understand that every effort to
contact me will be made in the event of illness or injury to my pet, but that this may not always be
possible before incurring expenses for necessary treatment.

However, if I am unable to be reached prior to the time when the performance of the necessary care is deemed to be required by the attending veterinarian, the hospital’s staff has my permission to provide such medical care for my pet.*

Yes

Initials for understanding the Emergency Care Plan*

Pick-up Time/Pet Abandonment Policy

A pick-up time is to be arranged at time of check-in. I agree, that either I, or an authorized agent of
mine will promptly pick-up my pet and pay for all accrued charges at the agreed upon date and time.
Please contact as soon as possible if you will not be able to pick-up your pet at the agreed upon time.
I understand that if I fail to contact the hospital and they are unable to reach me at any of the numbers
on record my pet will be considered abandoned after 5 days. The hospital may handle this
abandonment in the best interests of the pet and/or the hospital in accordance with the local laws and I
will still be responsible for all related fees including, but not limited to all medical and/or grooming
services performed, costs associated with keeping the animal, or collection fees.

Emergency Contacts

Emergency Contact Name*

Emergency Contact Phone*

I am the owner or authorized agent for the owner responsible for seeking grooming care for the animal
described above, and I have the authority to execute this consent. My signature below ceritifies that I
am over eighteen years of age. I assume responsibility for all charges incurred in the care of this pet
brought in by myself or another individual.

Name*

First

Last

Signature*

Date*

Preferred Phone Contact Number*

*Late cancelations/no-shows to scheduled appointments may be subject to associated fees*

This field is for validation purposes and should be left unchanged.

Grooming Consent Form

Client Information

Pet Information

Medical Requirements

Pet Health and Behavior Statements

Sedation Policy

Mat Removal Policy

Emergency Care Plan

Pick-up Time/Pet Abandonment Policy

Emergency Contacts

What's Next

Call us or schedule an
appointment online.

Meet with a doctor for an
initial exam.

Put a plan together for
your pet.

Where family pets find loving care

Grooming Consent Form

Client Information

Pet Information

Medical Requirements

Pet Health and Behavior Statements

Sedation Policy

Mat Removal Policy

Emergency Care Plan

Pick-up Time/Pet Abandonment Policy

Emergency Contacts

What's Next

Call us or schedule an appointment online.

Meet with a doctor for an initial exam.

Put a plan together for your pet.

Where family pets find loving care

Call us or schedule an
appointment online.

Meet with a doctor for an
initial exam.

Put a plan together for
your pet.