Eads Animal Hospital :: 901-867-PETS(7387) ::

Grooming Request Form
Important: Our online forms are as detailed as possible, to reduce paperwork, so please fill in all information.
Please fill out one form per animal you wish to have groomed.

1.	Client/Patient Information
	Owner's Name	Email Address
	Pet's Name	Pet's Doctor
	Coat Length Currently: Long Medium Short
	Pet's Coat Matted: Yes No
	New Client?

Home number:
( ) -

Work number:
( ) -

Street address:

City:

State:
(ex: TN - Tennessee)

Zip code:

Pet Information:

Breed:

Color:

Sex:
Male Female

Altered:
Spayed/Neutered

Pet's Size:
Adult Puppy/Kitten

Pet Weight :
lbs.

Vaccination History:

Yes, Eads Animal Hospital has my current vaccination records.

	If vaccinations have not been given by Eads Animal Hospital, please list the last place your pet was vaccinated at:
	Clinic/Hospital Name:	Phone number: ( ) -

2.	Contact number(s)
	Primary Contact Number: ( ) -	Secondary Contact Number: ( ) -

3.	Drop-off Information
	Drop-off date
	Note: Drop off time for all grooms is between 7:30 and 8:00 a.m. All grooms are usually ready to go by 2:00 p.m., however, earlier pick up times may be requested if necessary. If you want to request an earlier pick-up, please include the time and any other details you may wish in the "Other Information" section at the bottom of the page.

4.	Grooming Style :
	Shave:	Yes No
	Trim:	Long Medium Short None
	Trim:	Face Feet Tail Bottom
	Bath Only :	Yes No
	Grooming Instructions :

5.	Medical Attention Needed:
	Heartworm Test Dental Exam Check Ears Urine Test Vaccination Fecal Exam Check Skin Sedation Wellness Exam Bloodwork Check Lump
	List any other services needed below:

6.	Other Information:

7.	Grooming Policy
	All vaccinations are required for surgery, grooming, and boarding. If vaccinations have not been given by Eads Animal Hospital, please list the last place your pet was vaccinated at If vaccinations are unable to be verified your pet will receive all required vaccinations. In case of illness or injury, I, the undersigned, do hereby give my authorization and consent for the doctors of the hospital to treat, prescribe for, or operate upon my pet(s) while they are being groomed at the hospital. Eads Animal Hospital promotes a flea/tick free enviroment. If fleas are noted on the initial exam of patients admitted to the hospital a Capstar tablet will be given. This will be at and additional cost of $5.00. If ticks are noted, a flea and tick prevention will be given for an additional fee. It is necessary for some groom patients to receive a sedative or anesthesia. Eads Animal Hospital does does not have permission to give my pet a sedative or anesthetic agent. As with any sedative or anesthesia there is some risk involved. It is recommended that blood values be evaluated prior to any sedative or anesthesia. Eads Animal Hospital does does not have permission to run this bloodwork.
	I Agree to the grooming policy and that all information supplied above is correct.