New Customer Form

Client Details:

Only one form necessary for all pets! Please complete the policy form upon booking an appointment.
Owner(s) Names*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cell Phone Number*
E-mail*
Emergency/Secondary Contact Information for Pet Name and Phone Number
Pets Name(s) (list all dogs being groomed)*
Pets Breed(s)*
Pets Age(s)*
Pets Gender(s)*
Pets Weight(s)*
My pet(s) is/are up-to-date on:*

RabiesFlea & Tick Treatment
How often would you like to have your pet(s) groomed?*
When was your pet's last grooming?*
Health Concerns *check all that apply*:*

Heart issuesACL torn or repairedSkin issues/allergiesSeizuresArthritis/stiffness/trouble standingNoneDog aggression
Please specify if your pet as any known allergies:
Is there anything else we should know that could effect your pet's grooming?:
What days of the week are you available?*

MondayTuesdayWednesdayThursdayFridayI am flexible!
Are morning or afternoons preferred?*

MorningAfternoonI am flexible!
Are you interested in any of the following a-la-carte services? **Visit our "Services" page to learn more**

Toothbrushing ($5-toothbrush must be supplied)Nail Dremel ($10)Deep Conditioning/Moisturizing Treatment ($20)Paw Balm Treatment ($5)
Please sign (type) your name, agreeing that you have filled out the above information truthfully and to the best of your knowledge. *
Sign
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Client Details: