Owner's Name
Owner's Email
Your Phone
City
Dog's Name
Dog's Breed
Dog's Age
Dog's Weight
Dog's Gender
Spayed/Neutered YesNo
Does your dog have any loose teeth? YesNo
Health issues I should be aware of?
What is one word that you use to describe your dog's personality?
Last Dental Cleaning
Has your dog ever bitten anyone? Please provide details.
Thank you for your interest in making an appointment with K9 Smiles!I would appreciate it if you would fill in your paperwork before the day of your appointment. If you would like a printed version of the intake form and waiver for your personal records please let me know.
All animals (in particular older ones) can have unknown underlying health issues and there are always risks involved while working with animals as they can be unpredictable. K9 Smiles will take every precaution when handling your pet and I will do my very best to keep them safe while they are in my care. Your pets’ well being is extremely important to me. Service Disclaimer:
By utilizing the services provided by K9 Smiles, you acknowledge and agree to the following terms:
Risk Acknowledgment: You understand and accept that the services provided by K9 Smiles are undertaken at your own risk.
Waiver and Release: You hereby waive and release K9 Smiles, its directors, officers, employees, shareholders, volunteers, representatives, agents, and any affiliated host business, along with its employees and representatives (collectively referred to as "Released Parties"), from any, and all liabilities, claims, demands, causes of action, judgments, costs, or expenses (including legal expenses) arising out of or in connection with the services rendered.
Indemnification: You agree to indemnify and hold harmless K9 Smiles and the Released Parties from and against any, and all liabilities, claims, demands, damages, losses, costs, or expenses (including legal fees) incurred as a result of any act or omission on your part during the provision of the services.
Assumption of Responsibility: You acknowledge that you assume full responsibility for any risks associated with the services provided by K9 Smiles and that K9 Smiles and the Released Parties shall not be held liable for any damages or losses incurred as a result of such risks.
By engaging in our services, you signify your understanding and acceptance of these terms and agree to abide by them in their entirety.
By checking this box, I agree to all stated in this document and understand that in absence of a signature this will act as my approval to proceed with services.
