Owner's Name* Account #* Phone*Emergency Phone*Pet's Name* Dog or Cat* Dog Cat Age* Sex* Breed* Color* Spayed / Neutered* Yes No I AUTHORIZE WESTWOOD VETERINARY CLINIC,TO PERFORM THE TREATMENT/ PROCEDURE OR OPERATION DESCRIBED BELOW. I HAVE BEEN INFORMED OF THE REASONS FOR THE TREATMENT /PROCEDURE(S), ALONG WITH THE EXPECTED BENEFITS AND RISKS INVOLVEDPlease select the service your pet needsRegular Bath* SMALL (2-25 Lbs) MEDIUM (25-40 Lbs) LARGE (40-50 Lbs) X-LARGE(50-80 Lbs) GIANT (80-120 Lbs) Grooming* SMALL (2-25 Lbs) MEDIUM (25-40 Lbs) LARGE (40-50 Lbs) X-LARGE(50-80 Lbs) GIANT (80-120 Lbs) Dip* Fleas & Ticks Treatment Medicated Bath Fecal Vaccines **I AUTHORIZE THE GROOMER TO COMPLETELY SHAVE DOWN MY PET:* Yes No X Rays Blood Work EKG Vomiting Diarrhea Coughing Sneezing Eating Disorder Other I UNDERSTAND THAT UNFORESEEN CONDITIONS MAY REQUIRE AN EXTENSION OF A PLANNED PROCEDURE OR OPERATION. I HEREBY AUTHORIZE THE PERFORMANCE OF SUCH PROCEDURES OR OPERATIONS AS ARE NECESSARY AND ADVISABLE IN THE PROFESSIONAL JUDGEMENT OF THE VETERINARIAN. I AM WELL AWARE OF WESTWOOD VETERIANRY CLINIC’S OFFICE HOURS, WHICH ARE MON-FRI 9:00AM-6:00PM, SAT 9:00AM-4:00PM, SUNDAYS CLOSED.IF FOR ANY REASON I AM NOT ABLE TO PICK UP MY PET, DURING THEIR OFFICE HOURS, I KNOW THAT THERE WILL BE AN OVERNIGHT CHARGE, AND THAT THERE IS NO MEDICAL STAFF AFTER OFFICE HOURS. BY SIGNING BELOW, I ACKNOWLEDGE THAT IF MY PET IS BADLY MATTED, SENIOR, AND/OR RECEIVING THE SERVICES OF BEING GROOMED OR DEMATTED, THERE IS A POSSIBILITY THAT A MINOR CUT AND/OR INJURY MAY OCCUR. I AGREE THAT IF THE GROOMER FINDS THAT THE REQUESTED SERVICES IS UNABLE TO PERFORM COMPLETELY DO TO MATTING AND/OR AGE, THE GROOMER WILL PERFORM THE REQUESTED SERVICES TO THE BEST OF HIS/HER ABILITY I UNDERSTAND THAT I ASSUME ALL RISKS, I ASSUME RESPONSIBILITY FOR ALL CHARGES INCURRED IN THE CARE OF MY PET(S)AND ALSO THAT THESE CHARGES WILL BE PAID AT THE TIME OF RELEASEDate* MM slash DD slash YYYY Signature*CommentsThis field is for validation purposes and should be left unchanged.