Grooming With Sedation Release Form - Limerick Veterinary Hospital
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Limerick Veterinary Hospital
Grooming with Sedation Release Form
610.489.2848
“Thank you for trusting your best friend to us”
Owner's Name___________________________________Date__________________________________
Address___________________________________________________________________________
Home #_____________________Work#_____________________Cell#_______________________
Number where you can be reached (today): ______________________
Pet's Name__________________________Breed______________________Color________________
Age____________________________Sex___________________________Weight_____________________
Has this pet received any food or water since 9:00pm last evening?
Yes
No
(PLEASE COMPLETE THIS QUESTION AT HOSPITAL ADMITTANCE. IF YES, PLEASE
ALERT THE RECEPTIONIST)
Is this pet currently on any medications? No_____If yes, please list__________________________
Has this pet ever bitten, scratched or shown aggression toward anyone in any situation?
No______Yes_________If yes, please explain______________________________________________
I, Being responsible for the above-described animal, have the authority to grant you
consent to sedate my pet for grooming. I understand that if my pet needs to be examined
.
before sedation there will be an exam fee charged
Please check which service you would like for your pet.
*All grooms include a shampooing, conditioner treatment, brush out, nail trim, anal gland expression,
ear cleaning, and ear plucking if necessary.*
*
*Please note if your dog is severely matted, it may result in a total shave down
Brush out only.
Breed cut. In a pure bred dog, this will be done to breed standards unless otherwise
specified.
Total shave down. This cut will be as short as possible but skin will not show, tail will be left
longer and blended into the body.
Overall trim. This service includes furnishings (hind quarters, underside, legs, chest, and tail)
trimmed and excess hairs trimmed from around feet and face.
Puppy cut. Can be breed specific, but generally one length all over, with feet and face cut
shorter. Please specify in space below approximately how long you would like coat.
Special Instructions _________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Authorized Signature: _________________________________________Date: _________________________
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