Groom Admission Form- Not required for bath only

Welcome to Dowlen Road Veterinary Center _________________ (Pet's name)

Owner's Name: ______________________________           Weight:_________

Address: ______________________________

City,State,Zip: ______________________                 Pick Up:________

Home #: ________________________________Work #: ______________________

Circle where you can be reached today or leave an alternate #________________

                           

 GROOM ADMISSION FORM

<<<<<<THE GROOMING SERVICES ARE SEPARATE FROM THE DOWLEN ROAD VET CENTER><<<<

Grooming is an art. You, as the owner, must understand that the groomer will

follow your instructions to the best of their ability. 

 

If _________is matted,       will be shaved. Would you like to be called if this is determined to be necessary?            Yes         No

Would you like           to be groomed even if you can’t be reached?  Yes   No

 

TRANQUILIZATION: Do you authorize tranquilization if it is deemed necessary for the safe handling of ____________________?  (circle) Yes  or No  Cost $21.00

 

Please describe in detail the type of groom you wish to have for <animal> today.­­­­____________________________________________________________________                                                                       

 

Circle Choice:

 

  1. WHOLE BODY (Shave, trim, or leave as is)- TAIL (shave, trim, lion tail or leave as is)- HEAD (shave, teddy head, trim, or leave as is)- LEGS & FEET (shave, trim, or leave as is)- FACE (shave, trim, mustache or leave as is)- EARS (shave, trim or leave as is). Any other instructions:

­­­­­­­­­_____________________________________________________________________

  1. COLOGNE – POLISH – BOWS (We only polish poodles or shaved feet)
  2. Flea Treatment:  Yes  or  No    $18.99 (It will be done if we see fleas)

Circle Choice: Added Services for Today’s Groom (at only $10.00 each)

  1. Express Anal Glands
  2. File Nails (after clipping)
  3. Brush Teeth (for fresh breath)
  4. Hot Oil Treatment (for itchy skin)
  5. Sunscreen for dog applied (to shaved hair coat ONLY)

 

(Any three items above for $25.00)

(Get all five for $35.00)

 

IF ANY MEDICAL CONDITION IS NOTICED – DO YOU GIVE THE DOCTOR PERMISSION TO EXAMINE, TREAT <animal> AND PRESCRIBE MEDICATIONS? – (circle)  Yes  or No

 

Is cost a concern? – (circle)  Yes  or  No

 

Your limit on Amount for veterinary services today $_________ alone.

(The grooming department is separate and independent from Dowlen Road Veterinary Center.)

Please give 24 hours notice if you will not be able to make your grooming appointment. You could be subject to a No Show fee of $10.00 if you do not call 24 hours in advance.

 

Owner Signature: ____________________________    Date:­­____________________

Employee Initials ________________               Date _____________________