Perky Poodle Client Registration Form
Have your vaccination records handy in an electronic format before starting (be sure they include the expiration date of the rabies vaccine). You will need to upload them in order to submit the form.
Contact Information
Primary Contact
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
May we have permission to text you about your appointments? They will only be confirmations and reminders about appointments you set (no spam, no advertising).
Please Select
Yes
No
E-mail
*
We won't spam you - this is only for confirmations, vaccinations, etc
Additional Contact
First Name
Last Name
Phone Number
-
Area Code
Phone Number
Is there someone else who will often be picking up your pup (personal assistant, sister, etc)?
Yes
No
Name
First Name
Last Name
Phone Number
-
Area Code
Phone Number
Is this a referral?
Yes
No
What is the name of the groomer, bather, or person/pet who referred you?
We want to match you up with their team.
Pup Information
Pet’s Name
*
*
Female
Male
Breed
*
Weight
*
Add another pup
I just have one precious kiddo
Pet’s Name
Female
Male
Breed
Weight
Add another pup
I just have two precious kiddos
Pet’s Name
Female
Male
Breed
Weight
Add another pup
I just have three precious kiddos
Pet’s Name
Female
Male
Breed
Weight
Vet and Medical Info
Please upload vaccination records that show the expiration date of the rabies vaccine
*
Browse Files
A picture, screenshot, or PDF works perfectly.
Cancel
of
Vet Clinic
*
Phone Number
-
Area Code
Phone Number
Does your pup have any allergies or medical conditions
Yes
No
List any allergies or medical conditions
*
I understand that Perky Poodle will take my pet to the nearest possible vet clinic when deemed necessary in the rare event of a medical emergency.
Safety Information
Please read our safety policies and digitally sign below. Click the image for a larger version if needed.
*
I have read and accept the safety policies provided by Perky Poodle.
Submit
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