BLWA Bath Form 2024

BLWA Bath Form

Please fill out the checklist for each appointment.
Owner's Name*

First NameLast Name
Pet Name*
Best Phone Number*
Please enter a valid phone number. We will text when ready.
Do you prefer a text or phone call when your dog is ready to be picked up?*

Text MessagePhone Call
We have 2 bath packages to choose from. Please read the following options and choose which bath package you would like your dog to have!
BATH PACKAGES*
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Basic BathThe Basic Bath comes with Oatmeal Shampoo, Nail Trim, Anal Gland Expression, Ear Cleaning, Blow Dry & Brush out
$60.00

Deluxe BathThe Deluxe Bath comes with everything the Basic Bath comes with PLUS A Blueberry Facial, Teeth Wiping, Sanitary Clip & Paw Pad Fur Trim**! (**If your dog doesn't need a pad trim or sanitary clip, we will substitute for a de-shedding brush-out for you)
$100.00
Extra Bathing Add On Services

Extra Brushing $25Medicated Shampoo $10
Please list any additional services you need here. If you want to make any changes to your bathing services or have specific needs, you may also list them here for our bathing team to see.
We will text/call you as soon as your pet is finished. Pick up any time after 2pm!

**Please note that if your pet becomes stressed or fractious we will not perform any additional services for the safety of your pet as well as our staff.**

Consent for Treatment:
I am the owner or agent of the animal described above. I have authority to execute this consent and am over the age of 18. I hereby authorize and direct Brogli, Lane, Weaver & Alexander Animal Hospital to perform the above described procedure(s). The nature and purpose of the procedure(s) have been explained to me and I understand that no guarantee exists as to the results of diagnosis and treatment of the above said animal. I understand that I am responsible for and agree to pay all such fees and charges at the time of discharge.

I agree to pay, in full, for services rendered including those deemed necessary for medical or surgical complications due to unforeseen circumstances. If unforeseen conditions arise, in the judgement of the attending veterinarian, call for procedures and/or treatment other than those now being authorized, I authorize such procedures if reasonable efforts to contact me for further consent are unsuccessful.

I have read and understand this consent. By submitting this form, I agree to the terms as mentioned above.
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Date*

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