Grooming Appointment Form Please read and fill out this form fully to request a grooming appointment. Once received, we will be in touch typically within a few business days to follow up with you and set up an appointment. "*" indicates required fields Have we groomed your pet here before?* Yes No Welcome back!Our groomer Andrea is accepting new pets for existing clients of our practice for grooming, so long as she has availability. We may need some additional information to make sure you're set up in our system.Are you a client of the practice?*Have any of your pets received services of any kind from us previously? Yes - My pet and I have received services at Cilley Veterinary Clinic before. I have used services at Cilley Veterinary Clinic in the past, but my pet has not. Neither I nor my pet have received services at Cilley Veterinary Clinic in the past. Great! This means you and your pet should already be in our system.If we have not seen your pet here at the clinic for any services in the past, we will need some additional information to verify your account information in our system for you, and we will need to have your pets most up-to-date vaccination records sent to us prior to booking any appointments. To expedite this process, please contact your primary care veterinarian and have them email or fax us a copy of their most up to date, complete health records. (Alternately, they can send you a copy to forward to us.) All pets must be up to date on the required vaccinations prior to coming in for grooming.Unfortunately at this time, in order to better serve our existing clients and their pets, we are not able to accept new clients for grooming. Please feel free to check back in the future to see if this has changed, as it may in time.HiddenClient & Pet InfoConditional Logic applied for section; shows if existing client only.Owner's Name*What is your name? First Last Alternate name FieldAre there any other names the account might be under or that should be on the account? First Last Pet Name*What is your pet's name? (If more than one, please list them all or submit a separate form for each.) Pet Species*What species is your pet? (If "other," please let us know below in the "Additional Notes/Comments section" what you would like done for your pet.) Cat Dog Other Pet Breed*What breed is your pet? (For example, Golden Retriever, Labrador, Scottish fold, shorthair, etc) Cats must be current on rabies vaccination in order to receive grooming services, and we strongly recommend that cats be current on distemper vaccination (FVRCP) for their own protection from common contagious illnesses.Dogs must be current on the following vaccinations & tests to receive grooming services with us, in order to protect them and others from common contagious illnesses: Rabies Vaccine Canine Distemper, Parvovirus, and Adenovirus-2 Vaccine (usually a combination vaccine) Leptospirosis Vaccine Kennel Cough (aka Bordetella) Vaccine Canine Parainfluenza Vaccine (usually included in kennel cough or distemper combination vaccines) Canine Influenza Vaccine, for strains H3N2 and H3N8 Annual Heartworm Testing Health Requirements*Is your pet up to date on all of the health and vaccination requirements listed on the grooming page? (Please note that overdue vaccinations may need to be done at least 10 days prior to grooming.) Yes - I have verified this with my veterinarian. No Unsure Primary Care Veterinarian*What is the name of your primary care veterinarian? What office/hospital/clinic do they practice at? Please note that if your pet is overdue for or has not previously received any required vaccinations, they will need to be administered at least 10 days prior to any grooming visit, for their protection. Please contact your veterinarian to make sure your pet is up to date and/or schedule a visit if needed.What would you like done for your dog's grooming?*Which services would you like done for your dog? Bath Brushout Nail Trim Anal Gland Expression Haircut or Shave-Down Other What kind of haircut would you like for your dog?*Please describe what kind of haircut you would like. A simple trim-up? Full body shave-down? "The usual"? Something in-between? Feel free to be descriptive.If "Other" for grooming your dog:*Please describe in detail what you would like done for your dog.What would you like done for your cat's grooming?*Which services would you like done for your cat? (Please note that we typically do not recommend full water bathing on cats unless they are comfortable with it, as it can be very stressful for some cats; we offer Waterless Shampoo as a low-stress bathing alternative.) Also, please note that depending on the quality of the cat's hair coat, if there is matting, it may be impossible to brush it out - in such cases, mats typically need to be shaved out.) Haircut Brush out Nail Trim Waterless Shampoo Cleanup Water Bath Other What kind of haircut would you like for your cat?*Please describe in detail the haircut you would like for your kitty. (i.e. lion-cut, shave belly, hind-end trim-up, etc).If "Other" for grooming your cat:Please describe in detail what you would like done.May your cat require sedation to be safely handled during the grooming?* No, my cat has not needed sedation in the past. Yes, my cat does require sedation to be groomed safely. Unsure. Sometimes it is necessary for a cat to be sedated to be safely handled for grooming. We prefer not to sedate cats if it is avoidable. If your cat does require sedation, it must be discussed with and be authorized by a doctor prior to the grooming. Please note that there will be additional paperwork on drop-off, and that one of our doctors must have done a physical examination on your cat within the last year in order to be able to administer sedatives. If we feel we are unable to perform the grooming in a way that is safe for everyone involved, we will not perform the grooming. Safety is our priority.Additional Notes/Comments:Is there anything you would like to add regarding what you would like done for your pet's grooming?HiddenScheduling InfoConditional Logic applied for section; shows if existing client only.Are there certain days of the week that work best for you?*Our groomer will contact you with possible dates based on appointment availability and your selections below. All grooming pets are to be dropped off between 8-9am (ideally between 8-8:15) or on the hour as scheduled, and will have the option of being called when their grooming is finished, or can be picked up between 5-5:30pm. Mondays Tuesdays Wednesdays Thursdays Fridays Any days are fine. There are only specific dates that work for me. Please write the specific dates you would like to inquire about.*Please note that grooming can at times book out 4-5 weeks in advance, so specific dates will depend heavily on availability.Other Scheduling Notes*Do you have other scheduling preferences or constraints? For example, do you need drop off or pickup at a certain time, are you looking for the soonest available appointment, a particular week, or a certain number of weeks since their last appointment? Please note that grooming can at times book out 4-5 weeks in advance, so booking for specific dates or weeks will depend on availability.HiddenContact Info:Conditional Logic applied for section; shows if existing client only.Contact Info:*What are the best ways for us to contact you? Phone Email Other Phone Number*What is the best phone # to reach you?Email Address*What is the best email address to reach you? Enter Email Confirm Email Other Contact Method*What is the best way to reach you? Additional Comments or Notes:Please feel free to add any other notes, comments, or thoughts.CAPTCHAHiddenSubmit Button:Conditional Logic applied for section; shows if existing client only.