Grooming form

Owner's name: _______________________________________________

Address: ___________________________________________________

Pet's name: _________________ Dog or Cat ______________________

Breed: ___________DOB: ___________Coloring:___________

I certify that I am the owner of this pet and have the authority to

execute this consent. My pet is being presented to you for grooming.

I would like to have my pet groomed in the following manner:

____________________________________________________________

Included in every grooming is a nail trim and anal sac expression.

Your pet's ears will be checked for unusual odor or discharge, and if

any abnormality is noted we will notify you for permission to examine and

treat the ears. If you decline examination and treatment, the ears

will NOT be cleaned so as to avoid masking a potential infection.

Tooth brushing can be done for an additional charge of $10.00. Approval ( )

Out of the above, I do not want the following procedures performed:

____________________________________________________________

I am aware that Companion Animal Care Center requires that all patients admitted

for grooming be up to date on their Rabies and Distemper vaccines.

I trust that Companion Animal Care Center will exercise reasonable care and provide

clean, safe housing.

As owner of this pet, I realize that I am responsible for the above services to be paid in full at the time

of discharge.

Today, I can be contacted at ____________________________________

phone number

_________________________________ ____________________

signature of owner date