Grooming Application Step 1 of 4 25% Pet Parent InformationName(Required) First Last Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Email(Required) Enter Email Confirm Email Phone Number(Required)Preferred Method of Contact(Required) Phone Email Text Emergency ContactName(Required) First Last RelationEmergency Contact Phone Veterinarian InformationRockford Animal Hospital Client I am a client of Rockford Animal Hospital Veterinarian Hospital NameVeterinarian Contact NumberPet InformationSkip if current client of Rockford Animal Hospital.NameAgeBirthdaySexWeightColor/CoatBreed Add RemoveAdditional DetailsAdditional Pet Additional Pet? Pet Information #2Skip if current client of Rockford Animal Hospital.NameAgeBirthdaySexWeightColor/CoatBreed Add RemoveAdditional DetailsAdditional Pet #3 Additional Pet? Pet Information #3Skip if current client of Rockford Animal Hospital.NameAgeBirthdaySexWeightColor/CoatBreed Add RemoveAdditional Details Primary Service(s) NeededPlease check all that apply(Required) Dog Full Haircut Dog Trim (Neaten) Dog Bath & Brushout Feline Haircut Feline Brushout Feline Bath & Brush All grooming services include sanitary trim, feet and pads trim, nail trim, ear cleaning, two shampoos, conditioner, blow dry, brush, cologne, and bows or a bandana.Any other items you would like EXCLUDED from your service? Cologne Bandana Bow Other How did you hear about us? Social Media Website Outdoor Sign Referral/Friend Other Grooming WaiverThank you for choosing Rockford Animal Hospital for your grooming needs. Our mission is to deliver the best and most comprehensive grooming care available for your pet. We want to make the experience as safe and pleasant as possible for both you and your pet.Accidents: Grooming equipment is sharp, and although we use extreme caution and care in all situations, possible problems could occur including cuts, nicks, scratches, etc. Your pet’s safety and comfort are our number one priority. In the event an accident does occur, you will be notified of the accident. If Rockford Animal Hospital feels it is serious, and the owner is not on-site, Rockford Animal Hospital will provide immediate care for your pet. Health or Medical Problems: Occasionally, grooming can expose hidden medical issues or aggravate a current one. This can occur any time before, during, or after the grooming process. Should immediate attention be needed, Rockford Animal Hospital will proceed in the best interest of the pet. The owner is responsible for all services rendered in the event of a medical issue. Upon signing this waiver, you as the owner are authorizing Rockford Animal Hospital to proceed with any medical necessity for the well-being of your pet(s) while they are in the hospital for a grooming appointment. All costs incurred will be the responsibility of the owner. Vaccinations: All pets seen by grooming MUST be current on their rabies vaccination. Rockford Animal Hospital STRONGLY recommends pets be current on their distemper/parvo, bordetella, and influenza vaccinations as well. If you are not a current client of Rockford Animal Hospital, a copy of the rabies vaccination must be given prior to any grooming appointment. Work surfaces and kennels will be cleaned between patients. However, boarding within a hospital setting carries the risk of exposure to disease. Upon signing this waiver, the owner is aware of and understands the risk of their pet staying in the hospital for a grooming appointment. Fleas/Ticks/Parasites: If your pet is found to have fleas, ticks, or other parasites while in for their grooming appointment, Rockford Animal Hospital will administer the appropriate preventative/treatment to your pet at the cost to the owner. Matted Coats: Pets with matted coats require extra attention. The groomer will discuss any additional charges with you at intake. Matted fur can cause soars and infections. The groomer will discuss appropriate steps with you depending on the severity of the mats. To avoid undue stress and further damage to the pet’s skin, the groomer may recommend the pet be shaved down in these areas. After effective removal of the matted fur, your pet may exhibit behavioral changes. This is from the release of the tension and pain on the skin that had been building up. Use of Muzzles, Dangerous or Aggressive Pets: In some instances, a muzzle may be used to protect both the pet and the groomer. In the event that a pet is too nervous to proceed even with muzzling, Rockford Animal Hospital may require you to come back at a later date with your pet to continue services. To provide as stress-free of a visit as possible, Rockford Animal Hospital can prescribe pre-appointment anxiety medication for your pet. Should your pet become too anxious or aggressive to proceed with services, Rockford Animal Hospital reserves the right to charge you for grooming services performed up to the point of having to stop. Rockford Animal Hospital also reserves the right to refuse service to any pet that is at risk of causing harm to themselves or to staff. Satisfaction: It is important that you are satisfied with your grooming services. If for any reason you are dissatisfied with the services received, we would be happy to discuss an appropriate resolution. Should you take your pet home, however, before discussing any dissatisfaction, any return visits will be considered a new grooming appointment and you will be charged for those services. Cancellations/No Call-No Show: Since grooming appointments can be in very high demand, we ask that you inform us of the need to cancel or reschedule at least 24 hours in advance of your appointment. Failure to inform us of canceled or rescheduled appointments three times in a row will require services to be paid for upfront for any appointments to be scheduled. Waiver Acknowledgement(Required)I have reviewed this waiver and consent to all within. I affirm that I am the rightful legal owner of the pet(s) stated in this waiver. This waiver is valid for any future grooming appointments until I inform Rockford Animal Hospital in writing of any changes. Yes, I consent.Name(Required) First Last Date(Required) MM slash DD slash YYYY NameThis field is for validation purposes and should be left unchanged. Δ