Client Intake Form
Grooming Services
Owners Details
Owners Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
County
Postal Code
Phone Number
-
Area Code
Phone Number
Email
example@example.com
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Emergency/ Alternative Contact
Alternative Contact Name
First Name
Last Name
Alternative Contact Phone Number
-
Area Code
Phone Number
Relation to Owner
Do you allow your alternative/ emergency contact to make emergency medical decisions if you, the owner, are uncontactable?
Yes
No
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Animals Details
Animals Name
First Name
Last Name
Age
Breed
Gender
Male
Female
Are they Spayed/Neutered
Yes
No
To the best of your knowledge, has your dog ever shown signs of aggression at the groomers? Please provide details.
To the best of your knowledge, has your dog ever bitten anyone or shown signs of aggression to another human? Please provide details.
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Veterinary Details
Veterinary Practice
Veterinarian Name
First Name
Last Name
Veterinary Practice Address
Street Address
Street Address Line 2
City
County
Postal Code
Veterinary Contact Number
-
Area Code
Phone Number
Does your dog have any medical conditions? Please provide details including any and all medication.
To the best of your knowledge, does your dog have any allergies? Please provide details, this includes food allergies.
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Availability
Please detail below your general availability
Please provide a recent picture of your dog below.
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