GROOMING REGISTRATION FORM
OWNER INFORMATION
Last name:
 First name:
Address:
 Apt/Suite:
City:
 State:
 Zip Code:
How did you hear about us?
Email Address:
If a friend referred you, please tell us their name:
Home Phone:
 Work Phone:
 Cell Phone:
Emergency Contact (Name):
 Phone Number:
How would you like to receive your appointment reminders? Please check ONE:
Email Reminder
 Text Message
(standard text rates apply)
Please enter your full SMS
address OR cell phone provider:
Phone Call
CREDIT CARD INFORMATION
Credit cards are REQUIRED to make an appointment at My Two Dogs, Inc. Please have your credit card type, number,
and expiration date available when you call to make an appointment. We will keep this card on file. (However, you may
pay with another card or by cash).

CANCELLATION POLICY- If you need to cancel your appointment, you must give My Two Dogs at least 24 hours notice
or we will charge your credit card a non-refundable $20 cancellation fee at the time of your appointment. Please type
your name in the box below to state that you understand and agree to the credit card/cancellation policies.
Please type your initials:
DOG INFORMATION
Name:
 Breed:
 Weight:
Lbs.
Birthdate:
 Gender:
 M
 F
 Color(s):
Is your dog spayed/neutered?
 Yes
 No
DOG #2 INFORMATION
Name:
 Breed:
 Weight:
Lbs.
Birthdate:
 Gender:
 M
 F
 Color(s):
Is your dog spayed/neutered?
 Yes
 No
DOG #3 INFORMATION
Name:
 Breed:
 Weight:
Lbs.
Birthdate:
 Gender:
 M
 F
 Color(s):
Is your dog spayed/neutered?
 Yes
 No
MEDICAL INFORMATION
Veterinarian/Clinic Name:
Address:
 City:
Phone Number:
VACCINATION RECORDS
My Two Dogs Inc., in accordance with the City of New York, requires up to date vaccination records on all dogs who are
receiving services from our facility. This applies to both new and regular clients. It is your responsibility to make sure
we have your dog's current vaccination records before his/her appointment. If we do not have current records, your
dog's appointment will be rescheduled and a cancellation fee will be applied. Records can be faxed or emailed to us
from your vet. Please call our office to make sure we have received the records before your appointment.

I have read and understand the above statements/policies regarding vaccinations at My Two Dogs Inc.
Please type your initials:
Please tell us about any pre-existing
medical issues that your dog has:
Please tell us anything else you would
like us to know about your dog(s):