Grooming Request | Cornerstone Animal Hospital

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone Number*

Email*

Pet Information**

Name	Type of pet (Canine/Feline)	Sex	Neutered/ Spayed	Breed	Age/year /month	Weight

Are your pets vaccines current?*

Yes
No
Never Vaccinated

Are your pets current on Flea prevention?*

Yes
No
Never Used

Appointment 1st(Choice)*

Time*

: HH

MM

Appointment 2nd(Choice)

Time

: HH

MM

My pet has the medical condition

Other conditions requiring veterinary attention

I would like my pet to receive the following services:(at additional cost)

Other

Grooming Services

Desired Coat Length in Inches

I certify that I own or am the authorized agent for the above described pet, and I do hereby consent and authorize Cornerstone Animal Hospital and its staff to groom and care for my pet while it is under their care and supervision. I understand that I will be financially responsible to Cornerstone Animal Hospital for all charges related to the physical and medical care and services for this pet. I agree that all charges and fees will be paid in full at the time of discharge from Cornerstone Animal HospitalI hereby authorize Cornerstone Animal Hospital to groom, care for, and provide any medical treatment deemed necessary for the pet described above while being groomed.

Signature of owner or agent

Date

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