Your Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact
*
Name
Number
Email
*
example@example.com
What is your preferred method of contact?
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Dog Name
*
Breed(s) or a description if unknown
*
Date of birth (or approximate)
*
-
Month
-
Day
Year
Date
Is your dog a:
*
Male (neutered)
Male (intact)
Female (spayed)
Female (intact)
Approximate weight
*
Is your dog up to date on vaccinations?
*
Will need copy of vaccination records before/day of appointment
If you already have a copy of vaccination records, please upload here:
*
Browse Files
Drag and drop files here
Choose a file
Please be aware I will need either a physical copy or photo proof of vaccination records to keep an appointment.
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Veterinarians Name/Clinic
*
When was your dogs last professional grooming?
*
What services are you inquiring about?
*
example; bath, grooming, nails
Clinic Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
For grooming inquiries - If you have a past grooming you loved or an inspiration picture, please upload here:
Browse Files
Drag and drop files here
Choose a file
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Do you have any objections towards your dog receiving treats during his/her grooming? Any food restrictions or allergies?
*
Is your dog on any medications or have any medical problems or chronic illnesses?
*
Example: diabetes, seizures, arthritis, please list and explain.
Has your dog ever snapped at or bitten a person? If yes, please explain.
*
May we use photos we take of your dog on our Facebook page, website, or other advertising purposes?
*
Yes
No
Submit
Should be Empty: