Grooming Consent Form in Alexandria, VA

Date*

Owner*

First Last

Pet Info*

Name	Breed	Age

Does your pet have any allergies/skin allergies?*

Yes
No

Please describe your pet's allergies*

Does your pet have mobility issues?*

Yes
No

Please describe your pet's mobility issues*

Does your pet have any ongoing medical conditions?*

Yes
No

Please describe your pet's conditions*

Has your pet shown aversion/dislike of any of the following

Baths
Loud noises (like blow dryers)
Being brushed
Being Up On High Surfaces
Being In A Cage
Nail Trims
Anal Gland Expression

Other if not listed above

Grooming Instructions

I understand that for the health and safety of {PATIENT_NAME} and the staff of Harmony Animal Hospital, my pet needs to be up to date on the following vaccinations/tests:

Dogs: Annual Physical (within the past year), Rabies Vaccine, Distemper/Parvo Vaccine, Bordetella Vaccine, Negative Fecal Test (within the past year)

Cats: Annual Physical (within the past year), Rabies Vaccine, FVRCP Vaccine, Negative Fecal Test (within the past year)

If I am unable to provide proof of the above listed tests/vaccines Harmony Animal Hospital reserves the right to update any needed tests/vaccines at the owner's expense.

I verify that my pet has not, to my knowledge, bitten a person within the past 10 days.

Owner's Initials*

By my signature below I understand that payment must be rendered in full at the time of service. Accepted methods of payment are cash, Visa/Mastercard/Discover/AmEx. I understand that tips to the groomer will be made in cash only. There will a be a $35/pet Fee for NoShows or Same Day Cancellations. We would be happy to provide an estimate for grooming services upon request.

Signature*

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