Client Information and Consent Form Client Information and Consent Form Please enable JavaScript in your browser to complete this form.Name *FirstLastPhone Number * info info pet Alternate Number *Email *Address *City, State, Zip *Preferred Method of Contact *Primary Phone NumberAlternate Phone NumberEmailWould you like to receive monthly newsletters, if they are published?YesNoEmergency Contact InformationName *FirstLastPrimary Phone Number *Alternate Phone Number *Email *Pet's InformationName *Age *Pet Type/Breed *Sex *MaleFemaleVaccinated *YesNoNeutered/Spayed *YesNoInsuredYesNoMicrochipped *YesNoTreats allowed *YesNoAllergies/Intolerances *YesNoMore infoIf you answered yes to the above question, please explain.Medical Conditions *YesNoMore infoIf you answered yes to the above question, please explain.Health notes or medicationsSkin Conditions *YesNoMore infoIf you answered yes to the above question, please explain.Pet's TemperamentHas your pet ever shown signs of aggression towards a person? *YesNoPlease explainIf you answered yes to the previous questions, please explain.Any limited or impaired sensory functions? Example: Deaf or BlindDistinguishing featuresPet's Grooming and StylingFace *Body *Ears *Legs *Tail *When being groomed, my pet likes:When being groomed, my pet dislikes:Would you like a text reminder of grooming appointments? *YesNoClient ConsentConsent *I give my consentName *FirstLastBy typing your name, you are giving your consent.Submit
