Bath & Grooming Consent - Eastern Shore Animal Hospital & Urgent Care

Owner Name*

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Pet Name*

Species*

Breed*

Sex*

Male
Female

Color*

Weight*

Services Requested:

Professional Grooming

Includes Bathing, Shave/Trim (to be discussed with groomer), Blow Dry, Brush Out, Nail Trim, Ear Cleaning

Standard Bath performed by ESAH staff

Includes Bathing, Light Blow Dry, Brush Out

Our standard bath does not include hair trimming or shaving of any kind. If your pet has mats to be removed, an additional charge will be added.

Additional Services Requested:

Call for prices.

Ear Cleaning
Anal Sac Expression
Nail Trim
Nail Dremeling
Other

Other service requested:

- I understand that if fleas or ticks are seen, treatment will be provided and cost incurred by owner.
- As the owner or authorized guardian of the above named pet, I give Eastern Shore Animal Hospital permission to receive, treat, prescribe or otherwise care for my pet as deemed necessary should injury or circumstance occur. I understand that Eastern Shore Animal Hospital will try to contact the necessary people before treatment, but will exercise the option to proceed if no one is available for authorization.
- I accept all financial responsibilities for my pet and understand that payment for services rendered is due at the time of discharge.
- I consent for my pet to be photographed by Eastern Shore Animal Hospital. I further authorize that those photographs may be published for any purpose by Eastern Shore Animal Hospital.

I have read and fully understand the terms and conditions set forth above.

Electronic Signature

Date*
MM slash DD slash YYYY

Date

Phone number at which owner can be reached today or tomorrow.*

Bath & Grooming Consent Form

Services Requested: