208-788-8775
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Dog Parent Form (Grooming)
Parents Information
Name
Mr.
Mrs.
Miss
Ms.
Dr.
Prof.
Rev.
Prefix
First
Last
Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Phone
Email
Emergency Contact Information
Name
First & Last
Phone
Email
Dog info
Dogs Name:
Date of birth:
MM slash DD slash YYYY
Weight:
Breed(s):
Gender:
Neutered / Spayed:
Color(s):
Veterinarian Information:
Vet Phone Number:
Is your Dog friendly with other dogs?
Yes
No
Is your dog friendly with strangers?
Yes
No
Has your dog bitten or ever been bitten?
Yes
No
If yes please explain
Is it okay to give your dog a bone?
Yes
No
Does your Dog have any health issues that could limit or activity?
Does your Dog have any allergies?
Does your Dog have any skin conditions or special needs for grooming and bath?
How did you hear about us?
Referral
Phone Book
Veterinarian
Drive By
Internet
Other
Other:
Shots Required:
Rabies – 1 to 3 years
Bordetella (kennel Cough) – renew every 6 months
DAHLP – Parvo (lepto Shot not needed) – Given at least 24 hours to 7 days - every year
Canine Influenza – Every year
Monthly – Flea, tick, and lice Preventative Medication
Negative fecal test –within the past 6 months
