Canine Cuts All rights reserved
391 Harvard Street
Leominster, MA 01453
(978) 270-3113
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New Customer Form
If you are a new customer please fill out the form below so we will have your information before your arrival.
Please submit a form for each pet.
Please remember to bring a copy of your vaccination and rabies records!
First Name
Last Name
Address
City
State
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Zip Code
Phone
E-mail
Pet Name
Breed
Birth Date
Sex
Spayed Female
Neutered Male
Female
Male
Is your pet up to date on vaccinations?
Yes
No
Veterinary Clinic
Veterinary Phone
I have read and understand the '
Release and Hold Harmless Agreement
'
