The Doggerie - New Client Form

OWNER INFORMATION
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email
example@example.com

Veterinary Information
Name of Veterinarian or clinic
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Rabies expiration date

MonthDayYear
Date
List all medications including flea, tick & heart worm preventative*
(Type "NONE" if your pet does not take any medications or flea, tick and/or heart worm med)
List any medical conditions/problems*
(type "NONE" if your pet does not have any medical conditions or problems)

TERMS AND AGREEMENTS. Vaccinations: Florida State Statute 828.30 (1) (a) [Requires] all dogs, cats, and ferrets 4 months of age or older must be vaccinated by a licensed veterinarian or a person authorized under paragraph (b) against rabies with a vaccine that is licensed by the United States Department of Agriculture for use in those species. The Doggerie, LLC requires that your pet's Rabies vaccine is current. The Doggerie, LLC also strongly recommends your pet be vaccinated against certain infectious conditions, including Bordetella, DHPP, Leptospirosis, and Canine Influenza. Though your pet is vaccinated, it is still possible to become ill with an infectious condition. You agree to not hold The Doggerie, LLC liable in the event your pet becomes ill with an infectious condition during or after any service. Pre-Existing Conditions/Waiver: You agree The Doggerie, LLC is not responsible for any known or unknown pre-existing or degenerative medical conditions (or the aggravation of such conditions) such as heart disease, arthritis, intervertebral disc disease (IVDD), cruciate ligament tears, brachycephalic syndrome, infections, or any other medical problem that may be affected by the grooming process. You understand that shaving a matted pet may reveal pre-existing skin conditions that were unable to be identified prior to shaving and that The Doggerie, LLC is not responsible for issues that are revealed by or arise due to shaving a matted pet including skin irritations, poor hair re-growth, coat color changes, nicks to moles or skin growths, aural hematomas, and odd behaviors. In the event mats are found, you authorize The Doggerie, LLC to shave the matted area(s). Veterinary Treatment: In the unlikely event your pet becomes ill, injured, or requires medical attention, The Doggerie, LLC will attempt to notify you or your Agent as quickly as possible at the phone number(s) you provided. If we can't reach you or your Agent, or in the case of an emergency, you authorize The Doggerie, LLC and Tammie Richter to serve as your Agent and agree they may seek veterinary care and make healthcare decisions at your expense. You hereby knowingly, and with informed consent, authorize the release of all veterinary records to The Doggerie, LLC for any medical treatment received by your pet in possible connection with the service. Pet Parents must provide The Doggerie, LLC a copy of any veterinary report for any injury you claim occurred during the grooming process. Allergic/Adverse Reactions: You agree that The Doggerie, LLC is not responsible for allergic reactions resulting from the manufacturer-recommended usage of any products. Although a pet may experience an allergic reaction to grooming products at any time, flea and tick products are associated with a higher incidence of reactions. Please consult your veterinarian prior to having your pet treated if you have any questions concerning your pet's sensitivity to such treatments. IF FRONTLINE PLUS FOR DOGS HAS BEEN APPLIED, AVOID CONTACT WITH THE TREATED AREA UNTIL DRY. DO NOT ALLOW THE PRODUCT TO BE INGESTED. DO NOT USE FRONTLINE PLUS FOR DOGS ON CATS. Customer Information/ Indemnification: In the event your pet is involved in an incident (e.g. biting a person or another pet), you hereby authorize The Doggerie, LLC to release your name and contact information to any party involved in the Incident and/or the appropriate governmental authority. You agree to defend and indemnify The Doggerie, LLC for any claims, damages, or costs arising out of, or related to, any incident. Service: Your pet will be dried by, fluff dryer, kennel dryer, or velocity dryer. Please advise The Doggerie, LLC if you have a specific request for a drying method. Your pet will be tethered during the service. If we feel the safety or well-being of your pet and/or an associate is at risk, a muzzle may be used or we may refuse or discontinue service. Abandonment: Any pet not picked up within 12 hours of completion of a service may be, at our sole discretion, turned over to a local humane society or adoption agency. Any pet not picked up by the close of business will incure $15.00 per hour, or any partial hour thereafter, up to $50. Photo Release: The Doggerie, LLC may take a photo of your pet during grooming. You hereby grant The Doggerie, LLC, Inc. perpetual, irrevocable, royalty-free right and license to publish, distribute, adapt, modify, or otherwise use the Photo, or any portion thereof, in any manner for any commercial or non-commercial purpose without notice to you. Cancellation Policy: The Doggerie, LLC requires 24 hours notice when cancelling your appointment. Any notice less than 24 hours will be considered a “No Show”. No shows will be required to pay a $25 fee before rebooking an appointment.Agreement: You agree that clicking the “I Accept" button acts as your electronic signature, having the same effect as an original signature, and will constitute your acceptance of the terms and conditions herein. YOU AGREE THAT ALL INFORMATION YOU PROVIDED HEREIN IS CORRECT AND COMPLETE. IT IS YOUR RESPONSIBILITY TO NOTIFY THE DOGGERIE, LLC OF ANY CHANGES AT TIME OF CHECK-IN.*

I ACCEPT
By signing below, I confirm that I have thoroughly read and fully agree to the terms and conditions. The information provided on this 'Owner Information' form is accurate and complete to the best of my knowledge. *

Clear

By submitting this form, I agree to all terms and services contained herein. I certify that the information provided is true and accurate.*

I Agree
Should be Empty:

OWNER INFORMATION

PET INFORMATION

Veterinary Information