New Customer Intake Form - Trust & Harmony Mobile Grooming

Pet Parent Name*

Your email*

Phone*

Address

City

State

Zip

Other Authorized Handler

Handler's Email

Handler's Phone

Veterinarian Name

Veterinarian Phone

Why Mobile Grooming? Where did you hear about us?

Which Doggie Daycare Referred You?

Where did you hear about us?

Whoe Referred You?

Which veterinarian referred you?

Dog #1 Name

Breed

Weight (in Lbs)

Gender

DOB

Is the dog fixed?

Rabies Expiration Date

Kennel Cough Expiration Date

DHPP Expiration Date

What Flea/Tick preventative are you using?

What Treatment do You Use?

Grooming History Condition of Coat Health Issues

Behavioral Notes AnxiousFearfulHigh Energy

History of Biting?

Give Details

Is this dog food motivated? Favorite Treats or Dietary Restrictions/Food Allergies I have a 2nd dog

Dog #2 Name

Breed

Weight (in Lbs)

Gender

DOB

Is the dog fixed?

Rabies Expiration Date

Kennel Cough Expiration Date

DHPP Expiration Date

What Flea/Tick preventative are you using?

What Treatment do You Use?

Grooming History Condition of Coat Health Issues

Behavioral Notes AnxiousFearfulHigh Energy

History of Biting?

Give Details

Is this dog food motivated? Favorite Treats or Dietary Restrictions/Food Allergies I have a 3rd dog

Dog #3 Name

Breed

Weight (in Lbs)

Gender

DOB

Is the dog fixed?

Rabies Expiration Date

Kennel Cough Expiration Date

DHPP Expiration Date

What Flea/Tick preventative are you using?

What Treatment do You Use?

Grooming History Condition of Coat Health Issues

Behavioral Notes AnxiousFearfulHigh Energy

History of Biting?

Give Details

Is this dog food motivated? Favorite Treats or Dietary Restrictions/Food Allergies

Upload vaccine records (files should be 2mb or less)

Photos of your dog(s) (files should be 2mb or less)

Please read the following carefully. Checking the box will serve as your digital signature that you agree to my policies and service agreement: Policies & Service Agreement.

Please check here that you have read and agree to my policies and service agreement*

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