New Client Form

New Client Form
Customer Information
Owner Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Second Owner Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Email*
example@example.com
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact Name

First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.
Referred by:
Please include first/last name so they can receive a $10 referral credit.

Pet(s) Information

IF YOU ARE UNABLE TO UPLOAD YOUR PETS VET RECORDS, PLEASE EMAIL RABIES PAPERWORK TO SHAGGYCHICTIMONIUM@GMAIL.COM PRIOR TO YOUR APPOINTMENT
Pet Name *
Pet Name
Pet Name
Pet's Birthday(s) and Breed(s)*
Please list each pet, their breed and their birthdays mm/dd/yy
Groomer Preference
Please select who you would prefer to groom your pet. If no preference, please select "no preference".
Medical/Behavioral concerns
Please list any and all medical or behavioral (including bite history) concerns our groomers should be aware of.
Is your pet up to date on their rabies vaccine?*

YesNo
Please provide a copy of your pet's vaccination records here. If unable to upload, please email a copy to Shaggychictimonium@gmail.com prior to your pet's appointment.
Veterinarian Information*
Please include the practice name as well as phone number and address (if applicable) PLEASE EMAIL RABIES PAPERWORK TO SHAGGYCHICTIMONIUM@GMAIL.COM PRIOR TO YOUR PET'S APPOINTMENT.

Customer Information