Bath Release Form Client IDPatient IDClient Name*Patient NameAddress Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*SpeciesSexBirthdateWeightEmail* Facility IDSpecial Diet?VaccinationsNotesInstructions All pets left for bathing must be current on all required vaccinations and free of fleas and ticks. All pets will be treated prophylatcially for fleas upon arrival at the owner's expense.If medications are necessary for treatment or handling, I give my permission to the clinic to administer such medications.I authorize the clinic to do whatever is necessary in case of an illness or an emergency situation. All patients receiving a bath will receive a standard ear cleaning. For an additional $17.50, they may receive a nail trim and anal gland expression as well.AcceptDeclineI have given and read/understand the grooming policy.Emergency ContactPhoneSignature of Pet Owner or Person ResponsibleEnter Full NameToday's Date
