New Client Form

Client Information
Owner's name*

First NameLast Name
Today's Date*

MonthDayYear
Date
Owner's phone Number*
Please enter a valid phone number.
Owner's email address*
example@example.com
Owner's address*

Street Address

Street Address Line 2

CityState

Zip Code
Where would you prefer the grooming bus be parked? (Driveway, street, etc.) *PLEASE NOTE, the grooming bus is on the larger side.*
Pet's name*
Pet's breed*
Pet's age*
Your preferred vet*
Is your pet spayed/neutered?*

YesNo
Rabies vaccination EXPIRATION date*

MonthDayYear
Date
Is your pet on any type of flea and tick preventative?*

YesNo
Does your pet have any health issues or areas of concern? If so, please let me know below.
Are you alright with your pet getting perfume at the end of the service?*

YesNo
Are you alright with your pet getting treats during/after the service?*

YesNo
Are you alright with your pet getting a bandana at the end of the service?*

YesNo
Is there anything else you would like me to know about your pet?
***I have read and understand the policies of Elizabeth's Mobile Grooming*** (find these by clicking the “about” tab on my website)
Should be Empty:

Client Information