Welcome to Dowlen Road Veterinary Center _________________ (Pet's name)
Owner's Name: ______________________________ Weight:_________
City,State,Zip: ______________________ Pick Up:________
Home #: ________________________________Work #: ______________________
Circle where you can be reached today or leave an alternate #________________
GROOM ADMISSION FORM
<<<<<<THE GROOMING SERVICES ARE SEPARATE FROM THE DOWLEN ROAD VET CENTER><<<<
Grooming is an art. You, as the owner, must understand that the groomer will
follow your instructions to the best of their ability.
If _________is matted, will be shaved. Would you like to be called if this is determined to be necessary? Yes No
Would you like to be groomed even if you can’t be reached? Yes No
TRANQUILIZATION: Do you authorize tranquilization if it is deemed necessary for the safe handling of ____________________? (circle) Yes or No Cost $21.00
Please describe in detail the type of groom you wish to have for <animal> today.____________________________________________________________________
Circle Choice: Added Services for Today’s Groom (at only $10.00 each)
(Any three items above for $25.00)
(Get all five for $35.00)
IF ANY MEDICAL CONDITION IS NOTICED – DO YOU GIVE THE DOCTOR PERMISSION TO EXAMINE, TREAT <animal> AND PRESCRIBE MEDICATIONS? – (circle) Yes or No
Is cost a concern? – (circle) Yes or No
Your limit on Amount for veterinary services today $_________ alone.
(The grooming department is separate and independent from Dowlen Road Veterinary Center.)
Please give 24 hours notice if you will not be able to make your grooming appointment. You could be subject to a No Show fee of $10.00 if you do not call 24 hours in advance.
Owner Signature: ____________________________ Date:____________________
Employee Initials ________________ Date _____________________