In-home veterinary hospice and euthanasia services in northern Virginia and West Virginia

Grooming Consent Form

We look forward to seeing you soon! Please complete the form below before your appointment. if you have questions, please call us at 555-555-5555.

Client Information

Name *

First

Last

Phone *

Patient Information

Patient Name *

Species *

Breed

Weight

What type of grooming procedure is being done today? *

Are there any specific problems to address/be aware of or procedures to be performed during the grooming? *

I understand that a current rabies and distemper (and Bordetella for dogs) are required upon admission into Honor Veterinary Hospice. *

I understand

I also understand that a current (within a calendar year) heartworm test and stool check for intestinal parasites must also be up to date. *

I understand

Is the pet UTD on required vaccines and annual exam? *

I understand that in the event fleas are noted on my pet, Honor Veterinary Hospice will treat with appropriate parasite control medication while my pet is in the hospital, and I will be charged for the medication. *

I understand

Today's contact number for when pet is ready for pick-up *

EMERGENCIES: If the need for emergency care arises, I give my permission for such care to be administered as deemed necessary by the on-duty veterinarian at Honor Veterinary Hospice. *

I DO give permission
I DO NOT give permission

Date *

Signature *

Clear Signature

Website

Grooming Consent Form

Client Information

Patient Information

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Address

Contact Information

Hours

Appointment Request

Our business hours are as follows: