Client Registration & Consent Form Client Consent FormFirst NameLast NameAddressAddress Line 1Address Line 2CityPostcodeContact NumberAlternative Contact NumberEmailEmergency Contact NameEmergency Contact NumberRelationship to youDog DetailsAnd most importantly, tell us about your dog!NameBreedAgeDate of Birth (if known)Sex Male FemaleHas your dog been neutered/spayed? Yes NoColourApproximate WeightkgsIs your dog chipped? Yes NoDo you have pet insurance? Yes NoInsurance ProviderVets DetailsVets PracticeContact NumberAddressAddress Line 1Address Line 2CityPostcodeMedical DetailsIs your dog up to date with all Vaccinations? Yes NoHas your dog been diagnosed with any medical conditions? Yes NoPlease provide detailsIs your dog taking any medication? Yes NoPlease list medication and/or add additional detailDoes your dog have any allergies or sensitivities? Yes NoPlease provide detailsHas your dog ever had surgery or any significant injuries? Yes NoPlease provide detailsHas your dog ever suffered from any of the following:Heart ConditionAthritisHip DysplasiaEpilepsy/SeizuresDiabetesCushings DiseaseSkin ProblemsEar ProblemsEye ProblemsOtherNoneIf 'Other', please provide detailsBehaviour and Grooming HistoryHas your dog been professionally groomed before? Yes NoHow often is your dog groomed?Has your dog ever shown any of the following during grooming? Nervousness Aggression Biting Snapping Excessive Barking Separation Anxiety Fear of Dryers Fear of Clippers Fear of Nail Trimming NonePlease provide any additional information that may help us care for your dog:Has your dog ever bitten or injured a person or another animal? Yes NoPlease provide detailsCoat and SkinPlease tick any that apply: Matted Coat Sensitive Skin Dry Skin Flea Allergy Seasonal Allergies Lumps or Bumps Warts/Skin Tags None KnownPlease tell us about any areas that are particularly sensitive:ParasitesTo the best of your knowlege does your dog have: Fleas Ticks Mites NoneGrooming RequirementsPreferred Style Breed Standard Short & Practical Teddy Bear Style Hand Strip (where appropriate) As Recommended by GroomerSpecial Requests:Teeth CleaningWould you like information about our Ultrasonic Teeth Cleaning service? Yes NoPictures & Social MediaWould you be happy for images of your dogs to be included on our website and social media? Yes NoConsent I confirm that the information provided on this form is true and accurate to the best of my knowledge.I understand that it is my responsibility to inform Bennett & Hounds of any changes to my dog’s health, medication or behaviour before each appointment.I authorise Bennett & Hounds to seek veterinary treatment for my dog in the event of an emergency if I cannot be contacted. I understand that I will be responsible for any veterinary fees incurred.I understand that grooming equipment is sharp and, whilst every care is taken, minor nicks or irritation may occasionally occur, particularly where coats are matted, skin conditions are present or the dog moves unexpectedly.I have read and agree to abide by the Bennett & Hounds Terms & Conditions.Submit
