Book Grooming Form

Please fill in one application for each pet

Have you ever been here before? YesNo

First Name:
Last Name:
Email:
Address:

City:
Province:
Postal Code:
Country:
Home Phone Number:
Work Phone Number:
Cell Phone Number:
How did you hear about us?
Internet SearchAdvertisementFriendOther
If Other please specify:
Emergency Contact First Name:
Emergency Contact Last Name:
Contact Phone Number:
Contact Alt Phone Number:
Comments:

Pet's Name:
Species:
If Other please specify:
Breed:
Comments:

Add any descriptors you feel are applicable ex: long-hair/miniature/etc

Sex:
Height (in):
Weight (lbs):
Color:
Markings:

Add any descriptors you feel appropriate. Ex 3 white feet.

Tattoo or Microchip #
Birthdate (day/month/year)

Put an approximate date if unknown.

Pet Veterinary Clinic:

Please list the Veterinary Clinics official name.

Are there any medical conditions or allergies that we should be aware of?

Please specify any food or relevant allergies and list medical conditions we should be aware of or state N/A if not applicable.

Please list any medications your pet is taking - Time given and dosage

Name the medication - the number of times per day you give it. The time of day you give it and the dosage given or state N/A if not applicable.

Are there any other relevant details we should be aware of? Ex: Can clear 6 ft fences or stressed in thunderstorms

List anything you think may be of importance in your pets stay or state N/A if not applicable.


What date do you want your dog groomed?
Is there a second and third choice date that you can give us?
Is this the first time this dog has been groomed? YesNo

When was the last time this dog was groomed?
Were there any issues with grooming in the past?

Please let us know if the dog was scared, had clipper burn or stressed during a previous grooming?

Type of grooming required?

Please specify any particulars required. Ex:Bath and trim, Rake out dead coat, longer teddy bear, short face and feet, etc

Does the dog have any sensitivity to grooming products?

Does the dog have reactions to certain shampoos or is there a particular product you prefer?

Do you have any questions you would like to ask us?
Please have your vet fax your pet's vaccination record to 403-931-3782
Or email a copy to boarding@beinnein.com
Input this code: captcha