The Bearded Dog – Grooming Intake
Please complete this form before your pet’s grooming appointment so we can prepare safely and effectively.
Owner Information
Owner full name
*
First Name
Middle Name
Last Name
Phone number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email address
*
example@example.com
Street address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
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Angola
Anguilla
Antigua and Barbuda
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The Bahamas
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Bhutan
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Botswana
Brazil
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Bulgaria
Burkina Faso
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Cape Verde
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Central African Republic
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Chile
China
Christmas Island
Cocos (Keeling) Islands
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Cook Islands
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Cote d'Ivoire
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Cyprus
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Denmark
Djibouti
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Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
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Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
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The Gambia
Georgia
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Gibraltar
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Greenland
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Guinea
Guinea-Bissau
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Hungary
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Indonesia
Iran
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Ireland
Israel
Italy
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Japan
Jersey
Jordan
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Kenya
Kiribati
North Korea
South Korea
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Kuwait
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Laos
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Liberia
Libya
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Lithuania
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Madagascar
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Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
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Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
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eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
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United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
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Vietnam
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Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
City
State
ZIP code
Preferred contact method
*
Call
Text
Email
Pet Information
Pet Name
*
Species
*
Please Select
Dog
Cat
Rabbit
Bird
Other
Breed
Sex
Male
Female
Unknown
Spayed / Neutered
Yes
No
Unknown
Date of Birth
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Age (Years)
Color / Markings
Approximate Weight
Regular Veterinarian Name
Veterinary Clinic
Veterinarian Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Health & Safety
Are your pet's vaccinations current?
*
Yes
No
Unsure
Is your pet currently vaccinated against rabies?
*
Yes
No
Unsure
Rabies vaccination expiration date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Does your pet have any allergies or sensitivities?
Yes
No
Please describe any allergies or sensitivities
Does your pet have any medical conditions or take any medications?
Yes
No
Please list medical conditions and medications
Has your pet had any past surgeries or injuries?
Yes
No
Please describe any past surgeries or injuries
Does your pet have any other health concerns the groomer should know about?
Skin issues
Ear issues
Seizures
Heart issues
Respiratory issues
Mobility limitations
Other
Behavior & Grooming History
Has the pet received professional grooming before?
*
Yes
No
Not sure
Date of last grooming appointment
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Comfort level with bathing
Very uncomfortable
1
2
3
4
5
6
7
8
9
Very comfortable
10
1 is Very uncomfortable, 10 is Very comfortable
Comfort level with drying / blow dryer
Very uncomfortable
1
2
3
4
5
6
7
8
9
Very comfortable
10
1 is Very uncomfortable, 10 is Very comfortable
Comfort level with nail trimming
Very uncomfortable
1
2
3
4
5
6
7
8
9
Very comfortable
10
1 is Very uncomfortable, 10 is Very comfortable
Comfort level with face grooming
Very uncomfortable
1
2
3
4
5
6
7
8
9
Very comfortable
10
1 is Very uncomfortable, 10 is Very comfortable
Comfort level with feet handling
Very uncomfortable
1
2
3
4
5
6
7
8
9
Very comfortable
10
1 is Very uncomfortable, 10 is Very comfortable
Comfort level with ear cleaning
Very uncomfortable
1
2
3
4
5
6
7
8
9
Very comfortable
10
1 is Very uncomfortable, 10 is Very comfortable
Describe any fear or anxiety triggers
Has the pet ever bitten, snapped, or shown aggression during grooming?
No
Yes
Not sure
Describe behavior around other dogs
Does the pet have an escape risk?
No
Yes
Not sure
Grooming Request
Service Requested
*
Please Select
Bath & Brush
Full Groom
Mini Groom
Breed Standard Trim
Puppy Intro Groom
Other
Desired Haircut / Style
Please Select
Tidy Up
Short Pet Clip
Breed Standard Cut
Teddy Bear Cut
Lamb Cut
Lion Cut
Other
Coat Length Preference
Please Select
Very Short
Short
Medium
Long
Keep Current Length
Not Sure
Nail Service
Trim Only
Trim & File
No Nail Service
Not Sure
Ear Care
Clean Only
Pluck & Clean
No Ear Care
Not Sure
Teeth Brushing
Yes
No
Not Sure
De-shedding Service
Yes
No
Not Sure
Hand Stripping Requested
Yes
No
Not Sure
Matting / Tangles Notes
Reference Photos
Upload a File
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Policies & Consent
Acknowledgments
*
Grooming may be adjusted for my pet’s safety
Severe matting may require clipping
Additional fees may apply for extra time or coat condition
I understand the final groom may differ from my request due to coat condition or behavior
Emergency Care Authorization
*
If I cannot be reached, I authorize emergency veterinary care for my pet
I understand I am responsible for all related veterinary costs
Photo Permission
*
Before/After photos for records only
Before/After photos and social media use
No photos or social media use
Owner Certification
*
I certify the information I provided is true and accurate
I will inform the groomer of any changes to my pet’s health or behavior
Typed Signature
*
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Consent Reminder
Submit
Submit
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