New Client Intake Form

Dog Information

(If more than one dog, please list all on the same line)

Dog Name

Breed

Date of Birth

Please list any medical conditions such as skin or food allergies, hip dysplasia, recent surgeries, arthritis, being prone to seizures, anxiety, etc.

Owner Information

First name

Last name

Street Address

City

State

Zip

Cell Phone

Home Phone

Vet Information

Name of Dr.

Name of Vet Facility

Vet Street Address

City

State

Zip

Vet Facility Phone

Additional Information

How did you hear about Murph's Mobile Doggie Spa?

Regular bathing is imperative to maintaining your dog's health. Bathing returns the natural vitamins and oils back into the skin, prevents excessive shedding, and relieves allergens. Veterinarians recommend you use Murph's Mobile Doggie Spa every 2 to 4 weeks. The more you get your dog bathed, the less shedding and health problems you'll experience with your dog.

How often would you like your dog bathed?

Every 2 weeks

Every 4 weeks

May Murph's Mobile Doggie Spa have permission to take photographs of your dog(s) for promotional purposes?

Yes

It is the regulation of the Department of Agriculture to inform all Murph's Mobile Doggie Spa customers that their dog will be restrained while in our care. Please type or sign your name as a digital signature to agree to this.

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Cancellation Policy

All cancellations must be received to Murph's Mobile Doggie Spa at least 48 hours (2 business days) prior to appointment. If the appointment is on a Monday, cancellation must be made before the scheduled time on the prior Thursday. Any cancellations after the cancellation deadline will result in at $50 charge.

Terms & Conditions

The sole purpose for collecting your information is for Murph’s Mobile Doggie Spa records. At no time will your information be sold or passed on to another company.

You fully understand that: (a) there are inherent and potential risks involved with interactions between humans and dogs which may result in property damage or bodily injury including but not limited to permanent disability, sickness, or death to human or dog: and (b) there may be risk not known to you or Murph’s Mobile Doggie Spa, it’s contractors and assignees (Releasees), nor readily foreseeable at this time (collectively, “risks”). You fully accept and assume all risks and responsibility for all risks, including without limitations, all losses, costs, and damages incurred as a result of your use of our service. You hereby agree to expressly and forever generally waive, discharge, claims, indemnify, release from liability, save, hold harmless and defend Murph’s Mobile Doggie Spa, their invitees, owners, officers, directors, employees, contractors, agents, representatives, lessors and all others having an interest in any part of Murph’s Mobile Doggie Spa from and against any and all injury, liability, claims, litigation, actions, suits, costs, losses, damages, attorney’s fees, expense or demands of every character whatsoever on account or arising from or relating in any way to any act of the Releasees or your dog’s participation in any service provided by Murph’s Mobile Doggie Spa. You agree that this release is binding on you and your successors, heirs, legal representatives, and assignees. You also expressly and forever release the Releasees from any duty to protect you or your dog from injury of any kind and agree that the implementation of safety precautions by Murph’s Mobile Doggie Spa will not waive the Releasees’ right to be indemnified as provided hereunder and such precautions will not alter this release. I intend for this agreement to be a complete and unconditional release of all liability of the Releasees to the greatest extent permitted by law. I agree that if any portion of this agreement is held to become invalid or unenforceable, the remainder of this agreement will remain in full force and effect. Any controversy or claim arising out of or relating to this contract, or the breach thereof, shall be settled by arbitration administered by the American Arbitration Association under its Commercial Arbitration Rules. The number of arbitrators shall be one. The place of arbitration shall be Denver, Colorado. Colorado law shall apply. Judgment on the award rendered by the arbitrator may be entered in any court having jurisdiction thereof.