Client & Canine Intake Form

Coastal Canines Teeth Cleaning

1 Owner & Pet
2 Health
3 History
4 Waiver
👤 Owner Information
🐾 Pet Information
❤️ Health Information
📋 Cleaning History & Vet Info
📢 Behaviour & Social Media
📝 Liability Waiver & Release

Due to the nature of our appointments, late drop off cannot be accommodated. It is understood that if I am more than 10 minutes late for my appointment I will need to reschedule and my deposit will not be refundable. I am also aware that if I am more than 10 minutes late to pick up my pet a $50 late fee will be added to my bill.

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.

Coastal Canines Teeth Cleaning will take every precaution when handling your pet to do our very best to keep them safe while they are in our care. Your pet's well-being is extremely important to us.

By signing this form, I acknowledge that there are inherent risks to my pet in the performance of these services, including, but not limited to cuts, abrasions, infections, allergic reactions, muscle sprains or strains, or adverse reactions due to stress or undiagnosed health/dental issues.

I understand and acknowledge that the representatives of Coastal Canines Teeth Cleaning are not veterinarians and will not perform any veterinary medicine. I understand that sedation-free cleanings are a hygienic service and not meant to replace visits to a veterinarian or any veterinary dental service of any kind.

I understand that any information provided by the Coastal Canines team should be provided to my vet for follow-up inspection. I have been informed that my pet could potentially have dental issues that should be seen by a veterinarian and that a sedation-free cleaning may not be sufficient to maintain their oral health.

I agree that the services provided by Coastal Canines Teeth Cleaning are provided solely at my risk, and hereby waive and release Coastal Canines Teeth Cleaning, its directors, officers, employees, shareholders, volunteers, representatives, agents and the host business and its employees and representatives from and against any and all liabilities, claims, demands, causes of action, judgments, costs or expenses.

Total Cost: Anesthesia-free teeth cleaning: $229 + tax = $240.45

Please sign in the box below using your mouse or finger on touch devices.