Owner's Full Name
*
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Alternative Phone Number
Please enter a valid phone number.
Names
Address
*
Pet's Information
Pet's Name
*
Pet's Breed
*
Pet's Gender
*
Please Select
Male
Female
Pet's Weight
*
Pet's Age / DOB
*
Pet's Color
*
Pet's Medical
Veterinarian
*
Rabies Due Date
DHLP Due Date
Bordetella Due Date
Does your pet have any medical, physical, emotional, allergy, sensitivity, or pre-existing conditions? These may include prior surgeries, hip/joint issues, warts, moles, ear infections, or skin problems.
*
Yes
No
If Yes, Please Explain
Has your pet ever been aggressive toward or bit a groomer, other people, or other dogs?
*
Yes
No
If yes, Please explain
Additional Pets?
Do you have any additional pets you would like to add?
*
Yes
No
Additional Pet's Name
*
Additional Pet's Breed
*
Additional Pet's Gender
*
Please Select
Male
Female
Additional Pet's Weight
*
Additional Pet's Age / DOB
*
Additional Pet's Color
*
Additional Pet's Veterinarian
*
Additional Pet's Rabies Due Date
Additional Pet's DHLP Due Date
Additional Pet's Bordetella Due Date
Does your additional pet have any medical, physical, emotional, allergy, sensitivity, or pre-existing conditions? These may include prior surgeries, hip/joint issues, warts, moles, ear infections, or skin problems.
*
Yes
No
If yes, please explain regarding your additional pet.
Has your additional pet ever been aggressive toward or bit a groomer, other people, or other dogs?
*
Yes
No
If yes, please explain regarding your additional pet.
Do you have another additional pet you would like to add?
Yes
No
2nd Additional Pet's Name
*
2nd Additional Pet's Breed
*
2nd Additional Pet's Gender
*
Please Select
Male
Female
2nd Additional Pet's Weight
*
2nd Additional Pet's Age / DOB
*
2nd Additional Pet's Color
*
2nd Additional Pet's Veterinarian
*
2nd Additional Pet's Rabies Due Date
2nd Additional Pet's DHLP Due Date
2nd Additional Pet's Bordetella Due Date
Does your 2nd additional pet have any medical, physical, emotional, allergy, sensitivity, or pre-existing conditions? These may include prior surgeries, hip/joint issues, warts, moles, ear infections, or skin problems.
*
Yes
No
If yes, please explain regarding your additional pet.
Has your 2nd additional pet ever been aggressive toward or bit a groomer, other people, or other dogs?
*
Yes
No
If yes, Please explain
Do you have another additional pet you would like to add?
Yes
No
3rd Additional Pet's Name
*
3rd Additional Pet's Breed
*
3rd Additional Pet's Gender
*
Please Select
Male
Female
3rd Additional Pet's Weight
*
3rd Additional Pet's Age / DOB
*
3rd Additional Pet's Color
*
3rd Additional Pet's Veterinarian
*
3rd Additional Pet's Rabies Due Date
3rd Additional Pet's DHLP Due Date
3rd Additional Pet's Bordetella Due Date
Does your 3rd additional pet have any medical, physical, emotional, allergy, sensitivity, or pre-existing conditions? These may include prior surgeries, hip/joint issues, warts, moles, ear infections, or skin problems.
*
Yes
No
If yes, please explain regarding your additional pet.
Has your 3rd additional pet ever been aggressive toward or bit a groomer, other people, or other dogs?
*
Yes
No
If yes, Please explain
Do you have another additional pet you would like to add?
Yes
No
4th Additional Pet's Name
*
4th Additional Pet's Breed
*
4th Additional Pet's Gender
*
Please Select
Male
Female
4th Additional Pet's Weight
*
4th Additional Pet's Age / DOB
*
4th Additional Pet's Color
*
4th Additional Pet's Veterinarian
*
4th Additional Pet's Rabies Due Date
4th Additional Pet's DHLP Due Date
4th Additional Pet's Bordetella Due Date
Does your 4th additional pet have any medical, physical, emotional, allergy, sensitivity, or pre-existing conditions? These may include prior surgeries, hip/joint issues, warts, moles, ear infections, or skin problems.
*
Yes
No
If yes, please explain regarding your additional pet.
Has your 4th additional pet ever been aggressive toward or bit a groomer, other people, or other dogs?
*
Yes
No
If yes, Please explain
Do you have another additional pet you would like to add?
Yes
No
5th Additional Pet's Name
*
5th Additional Pet's Breed
*
5th Additional Pet's Gender
*
Please Select
Male
Female
5th Additional Pet's Weight
*
5th Additional Pet's Age / DOB
*
5th Additional Pet's Color
*
5th Additional Pet's Veterinarian
*
5th Additional Pet's Rabies Due Date
5th Additional Pet's DHLP Due Date
5th Additional Pet's Bordetella Due Date
Does your 5th additional pet have any medical, physical, emotional, allergy, sensitivity, or pre-existing conditions? These may include prior surgeries, hip/joint issues, warts, moles, ear infections, or skin problems.
*
Yes
No
If yes, please explain regarding your additional pet.
Has your 5th additional pet ever been aggressive toward or bit a groomer, other people, or other dogs?
*
Yes
No
If yes, Please explain
How did you hear about us?
May we photograph your pet(s) & potentially post to our website, social media, and/or print materials?
Yes
No
Is it ok to send you our quarterly newsletter?
*
Yes
No
I hereby give consent to Green Dog Spa to groom my pet and acknowledge that I have completed this form with accuracy
*
Yes
Green Dog Spa Policies for Client Services
We have your pets best interest at heart
Signature
*
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