Grooming Information/Health Form

Pet Owner's Name*

First Last

Phone Number*

Email*

Patient Name*

Date of APPT*

Name of the person dropping your pet off for the appointment:

First Last

Their Phone Number:

Does the person dropping your pet off have permission to make medical and financial decisions in your place?*

Yes
No

If not, list your DAYTIME NUMBER TO CONTACT as we will need to contact you for permission and payment information during the appointment.

Would you like the groomer to give the same haircut as your previous visit?

Yes
No

Please describe any changes/or your preferred haircut (please be as detailed as possible about the length of coat, if you would like one area longer than another, etc.):*

Pamper your pet with additional SPA SERVICES:

Spa Dremmel Nail Trim $26~ Makes your dog’s nails short and smooth by rounding all edges. Reducing scratches on your hardwood floors, furniture, and you!
Deshedding Shampoo & Conditioning Treatment $15-20 size dependant~ Dramatically reduce the amount of hair your pet sheds! While nothing will stop it completely, this works WONDERS!
Luxurious Conditioning Treatment $7.25~ Remoisturizing coconut cream conditioner that will leave your pooch silky smooth and smelling OOHH so good!
Blueberry Facial Treatments $12~ A lovely and refreshing treatment applied to the hair around the face and head to remove stubborn dirt, leaving behind silky hair and a hint of blueberry for puppy smooches!
Reiki/Massage Treatment $9.95~ Our groomer will set the "Mood" for a relaxing spa-like service with calming reiki and massage.
Teeth Brushing $11~ This is not just a tasty treat for your favorite companion, but also cleans teeth and freshens breath!

Please check any additional service you would like for your pet.

Is your pet coughing or sneezing?*

Yes
No

Is your pet currently taking a flea/tick preventative?*

Yes
No

Is your pet currently taking a heartworm preventative?*

Yes
No

Is your pet currently taking prescription medication(s) or supplements?*

Yes
No

Do you need medication refills?*

Yes
No

Does your pet have anxiety?*

Yes
No

Is your pet friendly?*

Yes
No

Have you noticed your pet behaving abnormally recently?*

Yes
No

Does your pet spend time scratching/licking/chewing their skin/fur?*

Yes
No

Does your pet experience stiffness/soreness?*

Yes
No

Have you noticed any new lumps or growths on your pet?*

Yes
No

Has your pet had a vaccine reaction, or become ill after receiving a vaccine in the past?*

Yes
No

What kind of dental care are you performing?*

Brushing
Dental Chew
Dental Diet
None

Please list any additional health history you’d like to share:*

608-643-2451

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