New Client Intake Form

Owner Information

Please provide your contact details.

First Name *

Last Name *

Email *

Address *

Address Line 2

City *

State *

Zip *

Cell Phone *

Home Phone

Emergency Contact Number * Same as my cell phone

Number of Pets *

Vaccination & Hospital Information

Upload current vaccination records. PDF, JPG, or PNG only, up to 11 files.

Animal Hospital Name *

Vaccination Certificates (up to 11 files, PDF/JPG/PNG, 8MB each max)

Tap to choose files or drag & drop here

Accepted: PDF, JPG, PNG · Max 8MB per file

Vaccination & Hospital Authorization

I certify that the vaccination and hospital information provided above is accurate and current. I understand that Coco Clips Dog Grooming requires proof of current Rabies, Distemper, and Bordetella vaccinations (and recommends Parvo and Influenza) administered by a licensed veterinarian.

I authorize Coco Clips Dog Grooming to contact the listed animal hospital to verify my pet's vaccination status and to consult with or refer my pet for emergency veterinary care if, in the sole judgment of the groomer, such care is necessary during the time my pet is in the salon's custody.

I agree to be financially responsible for any veterinary charges incurred for my pet during or as a result of services rendered by Coco Clips, including transportation, examination, and treatment charges, whether or not the groomer is determined to be at fault.

I have read and agree to the Vaccination & Hospital Authorization Agreement.

Matted Dog & Liability Release

Matted Dog Release

I acknowledge that matted coats can cause pain, tight pulling of the skin, and hidden skin conditions in my pet. Severely matted coats cannot be safely brushed out and must be shaved close to the skin. I understand that shaving a matted coat involves risk including, but not limited to: nicks or cuts from clipper blades close to the skin, razor burn, itching, scratching, behavior changes, brief disorientation, skin redness, and the potential exposure of pre-existing skin conditions.

I release and hold harmless Coco Clips Dog Grooming, its owners, employees, and agents, from any and all claims, liability, or damages arising from or in connection with the dematting or shaving of my pet's coat, and I authorize the groomer to use the professional technique the groomer determines to be safest for my pet.

I have read and agree to the Matted Dog Release.

Liability Release

I understand that grooming services are performed at my own risk. I agree that Coco Clips Dog Grooming, its owners, employees, and agents are not liable for injury, illness, loss, or escape of my pet during the grooming process except in the case of gross negligence. I acknowledge that older, senior, or special-needs pets can be at increased risk during grooming, and I accept that risk on behalf of my pet.

I authorize Coco Clips to photograph my pet for internal records and, unless I notify the salon in writing otherwise, for promotional use on the salon's website and social media.

I have read and agree to the Liability Release. I acknowledge that I have read and understood all of the above.

How Did You Find Us?

Referral Source (optional)

Payment Policy

Payment is due in full at the time of pickup. Coco Clips Dog Grooming accepts cash, debit, and all major credit cards. Personal checks are not accepted.

A 24-hour cancellation notice is required. Appointments cancelled with less than 24 hours' notice, or missed appointments (no-shows), may be charged 50% of the scheduled service price. Repeated no-shows may result in a pre-payment requirement for future appointments.

Additional charges may apply for severe matting, aggressive behavior requiring extra handling, de-shedding treatments, or extended grooming time. The groomer will inform you of any anticipated additional charges prior to performing the additional service whenever possible.

I have read and agree to the Payment Policy. I accept the Payment Policy as a condition of receiving service.

Signature

Please sign below using your finger (on phone/tablet) or mouse/trackpad.

Signer First Name *

Signer Last Name *

Signature Date *

Signature *

Signature is required.

I certify that all of the information I have provided on this form is accurate and complete to the best of my knowledge. I affirm that I am authorized to sign on behalf of the listed pet(s) and that I have read and understood all terms and releases in this form.