New Customer
Return Customer
FORM AGREEMENT – Return Customer
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We care about your pet’s safety and well-being and want to assure you that every effort will be made to make your pet’s service as pleasant as possible, and
BRIGHT N’ SHINE PET DENTAL®
technicians will take all precautions within its control to ensure the safety and welfare of your pet(s).
Pre-existing medical conditions, Acts of God, or any other event beyond our reasonable control can cause emergency situations. BRIGHT N’ SHINE PET DENTAL® cannot be held in liable for the outcome under these conditions.
Please read and confirm your understanding of each item listed below and please ask for clarification, if necessary, before signing.
> I represent that my pet(s) is/are in good health and current on required vaccination (Rabies).
> I have disclosed to BRIGHT N’ SHINE PET DENTAL® all know risks, dangers, and medical conditions associated with my pet(s).
> I represent that my pet(s) will be evaluated and deemed suitable for dental cleaning. I understand that BRIGHT N’ SHINE PET DENTAL® may refuse service to my pet(s) for any reason it deems necessary, including but not limited to, overly aggressive behavior and/or existing illnesses, poor dental health, etc.
> I allow BRIGHT N’ SHINE PET DENTAL® staff to communicate with my pet(s) veterinarian as deemed necessary should any injuries/medical issues attention. I agree that I am responsible for any medical bills incurred for my pet(s).
> I agree that BRIGHT N’ SHINE PET DENTAL® will not be liable for any illness or injury that may occur to my pet.
> I agree that BRIGHT N’ SHINE PET DENTAL® may use photos and videos of my pet(s) on social media or marketing campaigns and for training purposes.
With my signature below
I certify that I have read and understand all of the items above. I further agree to abide by the above and accept all terms and conditions as set out. In addition, I waive all claims or actions against
BRIGHT N’ SHINE PET DENTAL®
, relating to the care, control, health, and / or safety of my pet(s) arising while my pet(s) is in their care, and I release
BRIGHT N’ SHINE PET DENTAL®
and its employees from all responsibility if my pet(s) is injured in any way during the procedure, or in the case of sudden death.
THIS FORM MUST BE EMAILED OR HAND-DELIVERED TO BRIGHT N’ SHINE PET DENTAL® WITH AN ORIGINAL SIGNATURE PRIOR TO SERIVCE.
Primary Phone Number
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Secundary Phone Number
I agree to receive text messages about my schedule.
Yes
I agree to receive text messages about my schedule.
Yes
Owner Signature
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Technician Signature
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SENIOR PET / SPECIAL CONDITIONS WAIVER
We care about your pet’s safety and well-being; we want to assure you that every effort will be made to make your senior pet’s service as pleasant as possible.
Pre-existing medical conditions including loose teeth, Acts of God, or any other event beyond our control can cause emergency situations. We cannot be held liable for their outcome.
I release BRIGHT N’ SHINE PET DENTAL® and its employees from all responsibility if my pet(s) is injured in any way during the procedure, or in the case of sudden death. I understand that all precautions will be taken for the safety and welfare of my pet(s).
With my signature below I certify that I have read and understand the agreement and waiver. I agree to abide by and accept all terms and conditions as set out.
Please ask for clarification if necessary.
THIS FORM MUST BE EMAILED OR HAND-DELIVERED TO BRIGHT N’ SHINE PET DENTAL® WITH AN ORIGINAL SIGNATURE PRIOR TO SERIVCE.
Owner Signature
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Technician Signature
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Third Choice
Email
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First Time Only
First Name
Last Name
Phone Number
Zip Code
Email
Pet's Name
Age
Breed
Approx Weight
Suggested Date
Suggesst Time
08:00 AM
09:00 AM
10:00 AM
11:00 AM
01:00 PM
02:00 PM
03:00 PM
04:00 PM
05:00 PM
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