Grooming Consent Form | Hurstbourne Animal Hospital

Owner's Name:*

Contact Number:*

Late Pick-Up*

: HH

MM

Pet's Name:*

Breed:*

Health Conditions:*

Treats OK?*

Yes
No

Grooming Services*

Bath Basic (NO HAIRCUT, AT ALL)
Other (Be very Specific)

**All Grooms Include Ear Cleaning, Nail Trim, & Anal Gland Expression**

**Matted or Difficult Pets Will Incur Additional Fees Starting at $10**

**Groomers are not responsible for injuries on these types of pets.**

ADD-ON SERVICES WITH PURCHASE OF A GROOM*

Quantity of bottles:*

$4 per bottle

Veterinary Services

Canine*

Vaccine Clinic $135.10
Rabies
DH2PPC
Bordetella Nasal
Fecal
Heartworm & TickBone Illness Test
Heartworm Prevention

Feline*

Vaccine Clinic $95.10
Rabies
FVRCP
Fecal

DOCTOR PLEASE CHECK MY PET'S*

I authorize Hurstbourne Animal Hospital to use all reasonable precaution against injury,escape, or death of pet. The Hospital and staff will not be held liable any problems that develop,provided reasonable care and precaution are followed. I understand that any problems that develop with my pet will be treated as needed, and I assume full financial responsibility for the treatment and expenses incurred.

WE ARE NOT RESPONSIBLE FOR COLLARS OR LEASHES

Date*

Owner/Agent*