Head to Tail New Client Form
Transcription
Head to Tail New Client Form
Ph 843.225.4500 Fax 843.225.4577 info@headtotailpetcare.com *Items in red are required info Client Information Primary Owner: _______________________________________ Cell Phone: _______________________________ Spouse / Other: _______________________________________ Cell Phone: _______________________________ Address: _______________________________________________________________________________________ Home Phone: ________________________________________ Other Phone: ______________________________ Primary Email: __________________________________________________________________________________ Other Email: ____________________________________________________________________________________ Emergency Contact Name & Number: ______________________________________________________________ ***The emerency contact should be a local/nearby resident to call if the owners are unavailable*** How did you hear about us? ______________________________________________________________________ Vet Information Primary Vet Clinic: _______________________________________________________________________________ City, State & Phone: __________________________________________________________________________________ ***Please provide copies of current vaccination records, or have your vet fax them to us*** Pet Information Pet #1: Pet #2: Name: Breed: Color: Weight: Gender: Fixed: Date of Birth: Employee Notes: Employee Use Only Rabies: Bordatella: Distemper: Employee Use Only Rabies: Bordatella: Distemper: Please read and sign the back -----> Pet Information Pet #3: Pet #4: Name: Breed: Color: Weight: Gender: Fixed: Date of Birth: Employee Notes: Employee Use Only Rabies: Bordatella: Distemper: Employee Use Only Rabies: Bordatella: Distemper: General Services & Grooming Agreement Head to Tail Day Spa & Inn, LLC (referred to as Head to Tail LLC hereafter) agrees to provide services in a reliable and trustworthy manner. In consideration of these services and as an express condition thereof, the client agrees to waive any and all claims against Head to Tail LLC unless arising from negligence on the part of Head to Tail LLC. Client represents dog as being in good health, currently vaccinated and free of any communicable diseases. Client represents dog as non-aggressive. Client agrees dog has not harmed another animal, person or thing and has not shown any aggressive behavior. Client understands any harm caused by dog to another person, animal or property is the responsibility of the client. Head to Tail LLC does its best to be as careful as possible. There may be times when a dog is slightly injured due to sudden movements. Client understands and accepts these risks and will be notified of any incidents resulting in minor injury. In the event of a serious injury, and after all necessary attempts to reach the client fails, client authorizes Head to Tail LLC to seek medical attention at the client's vet clinic, Head to Tail's primary vet clinic (Ohlandt Veterinary Clinic) or at the nearest emergency vet clinic (Charleston Veterinary Referral Center). In the event the dog shows aggressive behavior and Head to Tail LLC cannot complete the job for fear of injury; client agrees to remain responsible for all applicable charges whether work is completed or not. If we cannot begin work, we will return dog to you with no charge. Client allows Head to Tail LLC to photograph or video their pets while in our care. These photos/videos may be used for marketing purposes. This agreement will remain valid for all future services. By signing below the client fully understands and agrees to the contents of this waiver and gives Head to Tail LLC the right to perform duties as described by client. Client Signature Date
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