Client Name(Required) First Last Pet's Name(Required) Contact NumberEmergency ContactPick–up time Hours : Minutes AM PM We will do our best to accommodate your schedule Call When Done Services included with a bath/grooming are nail trim, anal gland expression and light ear cleaning.Please note any special grooming requestsPersonal Belongings Petsadena Animal Hospital is not responsible for any personal belongings left with pet.Canine Vaccines needed: Rabies Bordetella Distemper/Parvo Feline Vaccines needed: Rabies Distemper Leukemia Is pet currently on flea prevention? Yes No Heartworm prevention? Yes No Do you need any Heartworm /Flea prevention today? Yes No If so, how many months? What kind? To eliminate any flea infestations, if fleas are seen on your pet, we will be administering Capstar, a safe, rapid, effective flea treatment, the fee will be added to your invoice ($6.80-$7.07). 1. All pets admitted for services must be current on vaccinations. Written proof of vaccinations or verification with the pet's veterinarian must be provided before any services can be provided to your pet(s). I consent that if vaccinations are overdue they will be administered and the cost will be added to the total bill. 2. All pets will be checked for parasites (fleas/ticks). If internal or external parasites are found by the veterinary staff while my pet is in for services, I consent to treatments as you determine, and the cost(s) of the treatment(s) will be added to my bill. 3. All precautions will be used to prevent injury/escape of my pet. Petsadena Animal Hospital and the team will not be held liable for any unforeseeable circumstances that may result in injury or death of my pet.Signature(Required) (Your digital signature (full name) is as legally binding as a physical signature.) Date MM slash DD slash YYYY
