New Client

Your Details

Your First and Last Name (required)

Your Email (required)

Primary Phone number (required)

Secondary Phone number (optional)

Contact Preference (required)
CallText

Address (required)

City (required)

State (required)

ZIP (required)

Your Pet Details

Pet(s) name(s) (required)

Species (required)
DogCat

Breed(s) (required)

Estimated Weight (required)

Birthday(s) - Estimated - (required)

Has your pet been groomed before? (required)
YesNo

Gender(s) (required)
MaleFemaleMale & FemaleFemale & Male

Veterinarian Name/Clinic (required)

Any current medical concerns?
YesNo

If yes, please list

Are there any sensitivities?
YesNo

If yes, please list

How frequently do you like to have your pet groomed:
1 week2 weeks4 weeks6 weeks8 weeks12 weeksFirst time

Vaccinations

All pets are strongly recommended to be current on all vaccinations, and are Required to be current on their Rabies vaccination in order to receive grooming services. Dogs are Required to be current on their Bordetella (Kennel Cough) vaccination. Cats are Required to be current on their FVRCP (Distemper) vaccination.

Pet Owner's Initials (required)

Fleas and Ticks

Mod Mutt Salon is proud to be a Flea Free Environment. If your pet has fleas, they will automatically be treated at your expense of $15.

Pet Owner's Initials (required)

Health Problems

Grooming can expose a hidden medical problem, or aggravate a current one. It is possible to occur during or after grooming. Please let us know of any health or medical issues. All medical expenses for veterinary care due to preexisting conditions will be covered by the pet’s owner.

Pet Owner's Initials (required)

Veterinarian Access

This release gives Mod Mutt authorization to seek medical treatment in case of any medical emergency while in our care.

Pet Owner's Initials (required)

Cancellations/No Shows

As a courtesy to our clients Mod Mutt offers confirmation texts the day before an appointment. If you are going to miss your pet’s appointment, please contact us. We require a 24 hour notice for rescheduling and cancellations. If you do not use, or do not cancel your appointment, a no show fee of $25 will be applied to your next grooming visit

Pet Owner's Initials (required)

Photographs

This release form gives Mod Mutt consent to take photos of your pet for your client file, our company website, and social media pages.

YesNo

I authorize this signed release form to be valid approval for future grooming services. This release form is valid for all pets that I currently own or will own in the future. I have read, signed, and agree to the above.

Pet Owner's Full Name (required)

Owner's Email (required)

Today's Date

Due to limited availability, in order to secure your appointment, we need to have the current vet records submitted before we confirm your pet's appointment. Please email or have your vet email the records to us at modmuttsalon@gmail.com