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Grooming Consent Form

We look forward to seeing you soon! Please complete the form below before your appointment. if you have questions, please call us at 555-555-5555.

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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 Arkansas Veterinary Clinic. *

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, Arkansas Veterinary Clinic 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 Arkansas Veterinary Clinic. *

I DO give permission
I DO NOT give permission

Date *

Signature *

Clear Signature

Message

Grooming Consent Form

Client Information

Patient Information

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Location

Contact Information

Hours