Pet Grooming

INFORMATION

Owner's Last Name (required)

Owner's First Name (required)

Primary Phone Number (required)

Secondary Phone Number

Your Email (required)

Address (required)

Dog's Name (required)

Dog's Gender (required)

Spayed or Neutered? (required)

Primary Breed (required)

Color (required)

Weight (required)

Dog's Age (required)

Emergency Contact (Other than Owner) Name (required)

Emergency Contact Phone Number (required)

Veterinary Information

Veterinary Name (required)

Veterinary Phone Number (required)

Flea/Tick Treatment

Is your dog currently on a Flea and/or Tick Treatment (required)

If yes, what type of treatment?

How did you hear about RollOver Pets Grooming? (required)

MEDICAL INFORMATION

Is your dog taking any medication? (required)

If yes, please name the medication and the reason:

Does your dog have any current or old injuries or health concerns? (required)

If yes, please describe:

Are there any other issues or concerns you wish to inform us about?

Pets are accepted for grooming only under the following conditions:
1. The animal is fit and healthy. Any grooming which takes place on an elderly animal
or animal with health problems will be at the owner’s risk. Grooming may expose pre-
existing health/skin problems for which the company cannot be held liable.
2. Your animal(s) vaccinations must be up to date (Rabies, DHLPP, Bordetella)
3. In the event of any injury or health concern, we are authorized to contact a
veterinarian and treat the pet, as necessary.
4. We DO NOT demat. It is too painful for animal(s), we only shave down.
5. Shaving/stripping will dramatically change the pet’s appearance and the hair will be
close to the skin. This may expose pre-existing skin conditions. By signing this form,
you agree to and understand these conditions.
6. Payment is due at check-out. Owner agrees that the pet will not leave the facility until
all charges due are paid. Payment will be made as per price list/quote and owners
must collect pets at time stated.
7. Price is determined by the groomer and is dependent upon breed, temperament, and
coat condition. Prices are not set and can vary from session to session.
8. Owner will be called when dog is ready, unless a time was agreed upon by the
owner and the groomer.
9. After 2 “no call no shows” or “day of cancellations,” your future appointments will be
cancelled. An appointment can be rescheduled if the owner prepays for the next
appointment at the time of scheduling.
10. If your dog has parasites (i.e.), fleas, ticks etc. there will be an additional fee for
treatment.

By submitting this form, I hereby agree to the foregoing as owner/caregiver of the pet:
Name of person submitting this form: (required)

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