DRVC Grooming Form

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

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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 today.­­­­____________________________________________________________________

Circle Choice:

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: _____________________________________________________________________

COLOGNE – POLISH – BOWS (We only polish poodles or shaved feet) 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)

Express Anal Glands File Nails (after clipping) Brush Teeth (for fresh breath) Hot Oil Treatment (for itchy skin) 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 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 _____________________