Grooming Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pet(s) before your visit.

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Client Information

Name *

First

Last

Phone *

Patient Information

Patient Name *

Species *

Breed

Weight

What type of grooming procedure is being done today? *

Are there any specific problems to address/be aware of or procedures to be performed during the grooming? *

I understand that a current rabies and distemper (and Bordetella for dogs) are required upon admission into Fairview Animal Hospital. *

I understand

I also understand that a current (within a calendar year) heartworm test and stool check for intestinal parasites must also be up to date. *

I understand

Is the pet UTD on required vaccines and annual exam? *

I understand that in the event fleas are noted on my pet, Fairview Animal Hospital will treat with appropriate parasite control medication while my pet is in the hospital, and I will be charged for the medication. *

I understand

Today's contact number for when pet is ready for pick-up *

EMERGENCIES: If the need for emergency care arises, I give my permission for such care to be administered as deemed necessary by the on-duty veterinarian at Fairview Animal Hospital. *

I DO give permission
I DO NOT give permission

Date *

Signature *

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Name

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Grooming Form

Client Information

Patient Information

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Hours