• NameType of pet (Canine/Feline)SexNeutered/ SpayedBreedAge/year /monthWeight 
  • MM slash DD slash YYYY
  • :
  • MM slash DD slash YYYY
  • :
  • 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.

  • MM slash DD slash YYYY