Name: _________________________________________ Phone #: _________________________
Address: _______________________________________ Cell Phone #:______________________
City: ______________________________ State: NJ Zip Code: ____________________
Pets Name: ____________________________ Male / Female
Breed : __________________________ Date Of Birth _____________ Age ___________
Rabies Expiration Date: ___________________
Medical Condition(s) Y/ N Allergies Y/N Describe: __________________________________
__________________________________________________________________________________
Veterinarian Info:
Name: __________________________________________
Address: ____________________________________________________
Phone#: ___________________________
Date ________________ Signature _________________________________________________
By signing above I agree to the following: I hereby certify that I am the owner and/or responsible party of the pet(s) described above and that the information supplied is correct. I agree to give updated information regarding any changes to the health of the pet(s) listed. I agree to give Doggie Treats Mobile Grooming permission to contact the veterinarian to verify any information, including health and immunization records. In the event of an emergency, I agree to provide medical treatment to my pet, at my expense. I agree to cancel my appointment within 24 hours to avoid missed appointment fees, ($25 per pet), in accordance with the company policy listed on the company website. I agree to make payment when services are rendered.
609-660-8388