Bleeding Injury Online Workshop
Pet Tech Pet CPR, First Aid, and Care in Nashua, NH

Updated Client Information Card

This is my client information card. Feel free to copy it, but, of course, change my information to yours.

 

 

Name____________________________________________________________________________________

Address__________________________________________________________________________________

Email____________________________________________________________________________________

Home phone__________________________________________________________________________________

Cell Phone___________________________________________________________________________________

Preferred method of contact________________________________________________________________

Name                 Breed             Age       Medical Concerns

  1. ___________________________________________________________________________________
  1. ___________________________________________________________________________________
  1. ___________________________________________________________________________________
  2. ___________________________________________________________________________________

Can your pet have a treat? Yes     No

In the event of a heart attack, I authorize Mary Oquendo of Pawsitively Pretty Mobile Grooming Salon LLC  (circle one) to perform not perform   CPR. I hold Mary Oquendo and Pawsitively Pretty Mobile Grooming Salon LLC harmless for these actions.

Signature and Date

In the event of a medical emergency and I can not be reached, I authorize Mary Oquendo and Pawsitively Pretty Mobile Grooming Salon LLC to bring my pet to the closest available veterinarian for treatment. I allow the veterinarian to treat my pet. I will be financially responsible unless Mary Oquendo and Pawsitively Pretty Mobile Grooming Salon LLC assume responsibility.

Signature and Date

 

In the event of inclement weather or natural disaster, Mary Oquendo and Pawsitively Pretty Mobile Grooming Salon LLC, is entrusted to use best judgment in caring for my pet and will not be held liable for consequences related to such decisions.

I also authorize Mary Oquendo and Pawsitively Pretty Mobile Grooming Salon LLC to assume guardianship over the following pets in my household until which time I can safely take possession of my pets.

_________________________________________________________________________________

Name and breed of other pets

Signature and Date

Veterinarian and Phone Number

Do you wish to be added to a quarterly newsletter that will have seasonal and safety tips as well as an invitation to a free webinar?

Yes   No

Can I use your pets photo in any marketing material such as Facebook and website?

Yes  No

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