Owner Information

Owner First Name (required)

Owner Last Name (required)

Address (required)

City State (required)

Zip Code (required)

Primary Phone (required)

Secondary Phone

Emergency Phone

Your email

Animal Information

Animal species (dog, cat, other)

Breed

Animal's name (required)

Sex

Birthdate (Month/year, or approximately)

Neutered or spayed?

Does your pet have any allergies?

Is your dog reactive?

Any mobility issues?

Diet?

Veterinarian Information

Veterinarian's business and name

Phone

When was the last time you visited a vet?

Has your pet been diagnosed with any significant issues?

If so, when?

Any health conditions CURRENTLY being treated by a vet?

Current medications?

Statement of Ownership and Consent (required)

Yes, I agree.

By checking the above box and signing this contract, I attest that I am the owner of the above-described animal, or have authorization from the owner to consent to get a massage and agree to hold Muddy Paws Bath House, it's owners, employees, officers, and directors harmless from any damage, loss, or claim arising from any condition, in accordance with the Client Massage Agreement. I hereby authorize the performance of professional therapeutic procedures including massage. I have been informed of the possible complications that can arise from massage, including but not limited to: sleepiness, soreness, limping, restlessness, etc.

Type for signature