New Customer Form

Set A Grooming Appointment

First Name*	Last Name*
Phone Number*	Email*

Pet Name*

Breed*

Appointment Date*	Grooming Service* Full Service Mini Groom Bath

Captcha:*

After submitting this form you will recieve a call from one of our staff to ether verify your scheduled appointment or provide you with information on the next avalible slot on the schedule.

Services Breakdown

Full Service Includes:	Mini Groom Service Includes:	Bath Service Includes:

Full Bath	Full Bath	Full Bath
Conditioner	Conditioner	Conditioner
Nails Trim and Filed	Nails Trim and Filed	Nails Trim and Filed
Ear Cleaning and Sanitation	Ear Cleaning and Sanitation	Ear Cleaning and Sanitation
Sanitary Clip and Paws Pads Trimmed	Sanitary Clip and Paws Pads Trimmed
Highest Quality Hair Cut	Face and Head Trim

Welcome to our new customer form that Wags To Riches requires for all new clients. We welcome you to complete this form online so that it will be on record when you come into the shop. If no form is on file you will have to complete this form on your first visit.

General Information

First Name*

Last Name*

Address*

City*

State*

Zip*

Home Phone

Cell Phone*

Work Phone

Email*

Referred By

Alternative Contact Information

We will contact this person in the event we can't reach you.

First Name*

Last Name*

Phone Number*

Pet Information

Pet Name*

Breed*

Color*

Weight*
Lbs

Male/Female*
Male Female

Neutered/Spayed*
Yes No

Shots*
Yes No

Birthday

Age*

Medical Information

Veterinarian

Doctor

Phone Number

Medical Conditions

Additional Information

Additional Notes

Acknowledgement

Initials*

By initaling this document you acknowledge the information on this document is correct
to the best of your knowledge.

* Required Feilds