PET PARENT INFORMATION

NAME:

CURRENT ADDRESS:

CITY:

STATE:

ZIP CODE:

EMAIL:

PHONE #

ALTERNATIVE #

VET INFORMATION

VET PRACTICE / NAME:

ADDRESS:

PHONE #

FAX #

CITY:

STATE:

ZIP CODE:

SECONDARY CONTACT

NAME:

PHONE #(s)

RELATIONSHIP:

PET: BASIC INFORMATION

NAME:                                                    

BREED:

COLOR:

DATE OF BIRTH (or celebration month):

MALE                    -                  FEMALE

SPAYED / NEUTERED:         YES             /              NO

RABIES VACC. EXPIRATION DATE:

BORDETELLA VACC. EXPIRATION DATE:

PARVOVIRUS VACC. EXPIRATION DATE:

DISTEMPER VACC. EXPIRATION DATE:

SPECIAL CARE INSTRUCTIONS:

 

 

ALLERGIES (if any):

 

SIGNATURE / AUTHORIZATION

SIGNATURE OF PET PARENT:

DATE:

I agree to allow Tails and Tangles Pet Grooming LLC to take and use pictures of my pet(s) in promotional material / on social media outlets (e.g. before and after pictures for groomer’s public portfolio)

YES:____________

NO:_____________