Grooming Release Form Client IDPatient IDClient Name*Patient NameAddress Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*SpeciesSexBirthdateWeightEmail* All prices discussed are starting base rate quotes. The groomer will determine whether additional charges.Shampoo?Works?Cut?VaccinationsNotesInstructionsAll pets left for grooming must be current on all required vaccinations and free of fleas and ticks. All pets will be treated prophylactically for fleas upon arrival at the owner's expense. Dogs are required to have up to date DHPP, Lepto, Bordetella, and Rabies. Dogs and cats must also have current negative fecal parasite examination. Cats are required to have up to date FVRCP and Rabies. A current wellness exam is required to update any vaccines. If medications are necessary for treatment or handling, I give my permission to the clinic to administer such medications.I authorize the clinic to do whatever is necessary in case of an emergency.AcceptDeclineI have given and read/understand the grooming policy.Emergency ContactPhoneEmergency ContactEnter Full NameToday's Date
