Jess'GroomRoomClientInfoSheet .pdf

Jess’ Groom Room
Client Information Sheet
Humans InformationName:______________________________ Date:________________
Address:_________________________________________________
City:_______________ State:___________________ Zip:___________
Home Phone:_________________ Cell Phone:_____________________
Work Phone:_______________ E-mail:__________________________
Others able to pick up your dog:__________________________________
*Your dog will not be released to anyone NOT on the above list- Unless discussed at drop off

Emergency Contact InformationName:_____________________ Home Phone:____________________
Cell Phone:__________________ Additional Phone:_________________
Veterinary/Medical InformationVeterinarian:_________________________ Phone:________________
Address:_________________________________________________
City:______________ State:________________ Zip:______________
Dog’s Vaccination Expiration Dates- Please also supply vet records.
Rabies:_________ Bordetella:_________ D/H/L/P(Distemper):________
Allergies?_______________________________________________
Flea and Tick Prevention: ☐Yes ☐No Brand:________________________
Any Lumps or bumps? ☐Yes ☐No *This includes fatty tumors, warts, etc.
*If yes, please explain where:_____________________________________
______________________________________________________
Any sensitive areas? ☐Yes ☐No *If yes please explain where:_______________
______________________________________________________
**If you have a preferred Emergency Veterinary Hospital please list it below.

_______________________________________________________
_______________________________________________________
_______________________________________________________
Dog’s InformationDog’s Name:________________________ Nickname:______________
Breed:_________________ Age:____________ D.O.B:_____________
Sex: ☐M- ☐Neutered ☐F- ☐Spayed Weight:________ Color:___________

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Has your dog ever bit anyone? ☐Yes ☐No *If yes, please explain the circumstances.
________________________________________________________
________________________________________________________
Does your dog have a tendency to show aggression? ☐Yes ☐No *If yes, please let us
know of possible triggers.

________________________________________________________
________________________________________________________
________________________________________________________
Grooming
Has your dog been to a groomer before? ☐Yes ☐No
To your knowledge, does your dog have problems in any of the following areas?
*If yes, please explain
☐Yes ☐No | Brushing_________________________________________
☐Yes ☐No | Bathing__________________________________________
☐Yes ☐No | Blow Drying_______________________________________
☐Yes ☐No | Nails____________________________________________
☐Yes ☐No | Ears____________________________________________
☐Yes ☐No | Clippers__________________________________________
☐Yes ☐No | Scissors__________________________________________
☐Yes ☐No | Head____________________________________________
☐Yes ☐No | Tail_____________________________________________
☐Yes ☐No | Legs_____________________________________________
☐Yes ☐No | Paws____________________________________________
Do you keep your dog in the same cut year round? ☐Yes ☐No ☐Does Not Apply
*For the groomer.

Additional Information:

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Dog’s InformationDog’s Name:________________________ Nickname:______________
Breed:_________________ Age:____________ D.O.B:_____________
Sex: ☐M- ☐Neutered ☐F- ☐Spayed Weight:________ Color:___________
Has your dog ever bit anyone? ☐Yes ☐No *If yes, please explain the circumstances.
________________________________________________________
________________________________________________________
Does your dog have a tendency to show aggression? ☐Yes ☐No *If yes, please let us
know of possible triggers.

________________________________________________________
________________________________________________________
________________________________________________________
Dog’s Vaccination Expiration Dates- Please also supply vet records.
Rabies:_________ Bordetella:_________ D/H/L/P(Distemper):________
Allergies?_______________________________________________
Flea and Tick Prevention: ☐Yes ☐No Brand:________________________
Any Lumps or bumps? ☐Yes ☐No *This includes fatty tumors, warts, etc.
*If yes, please explain where:_____________________________________
______________________________________________________
Any sensitive areas? ☐Yes ☐No *If yes please explain where:_______________
______________________________________________________
Grooming
Has your dog been to a groomer before? ☐Yes ☐No
To your knowledge, does your dog have problems in any of the following areas?
*If yes, please explain
☐Yes ☐No | Brushing_________________________________________
☐Yes ☐No | Bathing__________________________________________
☐Yes ☐No | Blow Drying_______________________________________
☐Yes ☐No | Nails____________________________________________
☐Yes ☐No | Ears____________________________________________
☐Yes ☐No | Clippers__________________________________________
☐Yes ☐No | Scissors__________________________________________
☐Yes ☐No | Head____________________________________________
☐Yes ☐No | Tail_____________________________________________
☐Yes ☐No | Legs_____________________________________________
☐Yes ☐No | Paws____________________________________________
Do you keep your dog in the same cut year round? ☐Yes ☐No ☐Does Not Apply

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*For the groomer.

Additional Information:

Jess' Groom Room Client Information Sheet
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