First Name *

Last Name *

Phone *

Email *

Address *

City *

State *

Postal code *

Co-guardian/ emergency Contact Name *

Co-guardian / emergency contact email

Dog's sex *

Male

Female

Co-guardian / emergency contact phone *

Dog's Breed (or mixed) *

Dog's Name *

Dog's weight *

Dog's date of birth *

Is your dog neutered/spayed *

Yes/No

YES
NO
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Has this dog experienced any of the following medical challenges in the previous six months? (Check All that Apply) *

None
Ear Infection
Eye Infection
Allergies
Gastritis/Bloating
Heat Stroke
Worms (heart/tape)
Canine “Kennel” Cough
Seizures
Urinary Tract Infection
Rash after grooming
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Has your dog experienced any issues in past grooms? Please describe *

Which fear-free grooming services are you interested in? (all that apply) *

The Basics (including bath and nail trim)
Clean Up Cut (The Basics plus a partial haircut or touch up of up to three areas of the body, such as the feet, face, undercarriage, or sanitary areas, to make your pup tidy between full grooms)
Full Groom (The Basics plus a breed standard haircut/style)
A Puppy’s First Grooming Appointment (less than 4 months old)
Fear-Free Dog Husbandry Training to help my dog overcome grooming related fears or known prior history
Transportation for Grooming
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Are you an existing or previous customer at Patrick’s Pet Care?

Yes
No
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How long have you had this dog in your family? *

Does this pet have any physical special needs that require special accommodation such as being in a wheelchair or being unable to stand for an hour during grooming due to age, infirmity, or some other reason? *

Yes
No
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Has the dog ever experienced any of these behavior challenges in the last 6 months? (Check all that apply) *

None
Attempting to escape over a barrier such as a gate or fence at home
Attempting to escape over a barrier such as a gate or fence in a dog daycare setting
Rushing to get through doors or gates
Barking or growling at other dogs or people trhough windows/fences/doors
Excessive barking generally
Shyness
Growls at other dogs/animals
Growls at humans
Snaps at humans
Snaps at other dogs
Snaps at grooming equipment
Separation anxiety (bonded to one person and cannot be away from that person))
Separation distress (struggles to be alone, but is calm around any person, it does not have to be a particular person))
Resource guarding
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Has this dog ever been to a professional dog groomer before? *

Yes
No
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Who is your dog's primary veterinarian *

Has your dog ever bitten another dog? *

Yes

Has your dog ever bitten a person? *

Yes

Does your dog have any medical conditions or take any medications we should be aware of? *

Please upload a picture of your dog *

Please upload vaccination records (we will ask for them later if not uploaded)