Grooming Release (Updated)

Grooming Release
***We close at 7:00 PM on Fridays. If you are late for pick-up, you will incur an overnight boarding fee (cost is based on weight).***
Date*

MonthDayYear
Date
Owner's Name*

First NameLast Name
Pet's Name*
VETERINARY SERVICES: For admission for grooming, we require that your dog is up-to-date on a Rabies Vaccine, Dist-Hep-Parain-Parvo Vaccine, Bordetella Vaccine, and Fecal Test (every 6 months). An $94.00 preventive care exam/office visit with a veterinarian is necessary when vaccines are administered.
My dog is due for the following:*

ExamRabies VaccineDHPP VaccineBordetella VaccineFecal TestLepto Vaccine (not required)Lyme Vaccine (not required)4DX Test (not required)UP-TO-DATE
GROOMING SERVICES:
Does your pet need a medicated shampoo?*

YesNo
If yes, what is the name of the shampoo? This shampoo must be provided by you or purchased from us at check-in.
I WOULD LIKE MY PET GROOMED IN THE FOLLOWING WAY:*
Expected pick-up time is between 4:00 PM - 7:00 PM on Fridays. Rush service is available for an additional fee ($30.00). Does your pet need rush service?*

YesNo
Grooming includes nail trimming and ear cleaning (if needed) at no additional cost. Select below if you would like us to also perform the following (see additional cost):

$47.00 Anal glands expressed (by a Veterinary Technician)$17.00 Teeth brushed (must provide or purchase toothbrush & toothpaste. This will remove plaque, but not tartar and should be done daily for best results.)
BY SIGNING HERE, I authorize and will pay in full for the above services, and I confirm that I am the owner or authorized agent for the above pet.*

Clear
Phone number where I can be reached today (required):*
Please enter a valid phone number.
Email where I can be reached today (optional):
example@example.com
Should be Empty: