Grooming Consent Form

Please fill out the new patient form.

First Name

Last Name

Email Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone Number

Alternate Phone Number

Today Contact Number

Today Alternate Contact Number

Pet Name

Species

Breed

Age or Date of Birth

Sex

Female

Spayed Female

Male

Neutered Male

Reason for Visit

Please list any personal items that you are leaving with your pet

As per hospital and grooming protocol, please note that if it is discovered that your pet has fleas while here for grooming, a doctor recommended flea treatment will be applied at the owners expense

I have read and understand.

I, the undersigned owner/authorized agent of the above listed patient, hereby authorized Badger Veterinary Hospital - Janesville and its staff to administer veterinary care to my animal. I understand that an estimate of the fees for veterinary services can be provided to me prior to service and that I am encouraged to discuss all fees related to such care before services are rendered. I agree to assume financial responsibility for the care provided here. All patients are discharged at the end of each business day; I realize that I am responsible for arranging pick up of my pet prior to the end of the business day. If emergency treatment is required and I cannot be reached, I authorize that life preserving action be taken for my pet until I can be contacted. I agree to assume full and complete financial responsibility for the balance of ALL services rendered (we accept cash, Visa, MC, Amex ,and Discover) at the time my pet is discharged.

I assume full responsibility for all charges incurred for this case and agree that payment of these charges will be made or arranged for before the animal is released.

Yes

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Grooming Consent Form

Option 1

Complete Online

Option 2

Complete on Arrival

Grooming Consent Form

New Patients Welcome