Intake Form

We can’t wait to meet you and your playful pooch!

If you are a new client, in order to receive dog care from Tail Wag Walkers, please fill out and submit the following Intake Form. We will be in touch soon. Thank you!

**We are currently at capacity for dog walking, and we are no longer accepting new dog walking clients. However, we are still accepting new clients for doggie day care, overnight boarding, baths & brushing.**

Click here to view our Doggie Day Care/Overnight Boarding availability.

Dog Owner's Information

Name of Owner *

First

Last

Name of Owner #2 (If Applicable)

First

Last

Address *

Address Line 1

City

State

Zip Code

Phone Number of Owner *

Phone Number of Owner #2 (If Applicable)

Email *

Emergency Contact

(Please note: We may release your pet to this person in the event of an emergency if you are unreachable.)

Name of Emergency Contact *

First

Last

Relationship *

Phone Number of Emergency Contact *

United States+1
United Kingdom+44
Afghanistan+93
Albania+355
Algeria+213
American Samoa+1
Andorra+376
Angola+244
Anguilla+1
Antigua & Barbuda+1
Argentina+54
Armenia+374
Aruba+297
Ascension Island+247
Australia+61
Austria+43
Azerbaijan+994
Bahamas+1
Bahrain+973
Bangladesh+880
Barbados+1
Belarus+375
Belgium+32
Belize+501
Benin+229
Bermuda+1
Bhutan+975
Bolivia+591
Bosnia & Herzegovina+387
Botswana+267
Brazil+55
British Indian Ocean Territory+246
British Virgin Islands+1
Brunei+673
Bulgaria+359
Burkina Faso+226
Burundi+257
Cambodia+855
Cameroon+237
Canada+1
Cape Verde+238
Caribbean Netherlands+599
Cayman Islands+1
Central African Republic+236
Chad+235
Chile+56
China+86
Christmas Island+61
Cocos (Keeling) Islands+61
Colombia+57
Comoros+269
Congo - Brazzaville+242
Congo - Kinshasa+243
Cook Islands+682
Costa Rica+506
Croatia+385
Cuba+53
Curaçao+599
Cyprus+357
Czech Republic+420
Côte d’Ivoire+225
Denmark+45
Djibouti+253
Dominica+1
Dominican Republic+1
Ecuador+593
Egypt+20
El Salvador+503
Equatorial Guinea+240
Eritrea+291
Estonia+372
Eswatini+268
Ethiopia+251
Falkland Islands+500
Faroe Islands+298
Fiji+679
Finland+358
France+33
French Guiana+594
French Polynesia+689
Gabon+241
Gambia+220
Georgia+995
Germany+49
Ghana+233
Gibraltar+350
Greece+30
Greenland+299
Grenada+1
Guadeloupe+590
Guam+1
Guatemala+502
Guernsey+44
Guinea+224
Guinea-Bissau+245
Guyana+592
Haiti+509
Honduras+504
Hong Kong+852
Hungary+36
Iceland+354
India+91
Indonesia+62
Iran+98
Iraq+964
Ireland+353
Isle of Man+44
Israel+972
Italy+39
Jamaica+1
Japan+81
Jersey+44
Jordan+962
Kazakhstan+7
Kenya+254
Kiribati+686
Kosovo+383
Kuwait+965
Kyrgyzstan+996
Laos+856
Latvia+371
Lebanon+961
Lesotho+266
Liberia+231
Libya+218
Liechtenstein+423
Lithuania+370
Luxembourg+352
Macau+853
Madagascar+261
Malawi+265
Malaysia+60
Maldives+960
Mali+223
Malta+356
Marshall Islands+692
Martinique+596
Mauritania+222
Mauritius+230
Mayotte+262
Mexico+52
Micronesia+691
Moldova+373
Monaco+377
Mongolia+976
Montenegro+382
Montserrat+1
Morocco+212
Mozambique+258
Myanmar (Burma)+95
Namibia+264
Nauru+674
Nepal+977
Netherlands+31
New Caledonia+687
New Zealand+64
Nicaragua+505
Niger+227
Nigeria+234
Niue+683
Norfolk Island+672
North Korea+850
North Macedonia+389
Northern Mariana Islands+1
Norway+47
Oman+968
Pakistan+92
Palau+680
Palestine+970
Panama+507
Papua New Guinea+675
Paraguay+595
Peru+51
Philippines+63
Poland+48
Portugal+351
Puerto Rico+1
Qatar+974
Romania+40
Russia+7
Rwanda+250
Réunion+262
Samoa+685
San Marino+378
Saudi Arabia+966
Senegal+221
Serbia+381
Seychelles+248
Sierra Leone+232
Singapore+65
Sint Maarten+1
Slovakia+421
Slovenia+386
Solomon Islands+677
Somalia+252
South Africa+27
South Korea+82
South Sudan+211
Spain+34
Sri Lanka+94
St Barthélemy+590
St Helena+290
St Kitts & Nevis+1
St Lucia+1
St Martin+590
St Pierre & Miquelon+508
St Vincent & Grenadines+1
Sudan+249
Suriname+597
Svalbard & Jan Mayen+47
Sweden+46
Switzerland+41
Syria+963
São Tomé & Príncipe+239
Taiwan+886
Tajikistan+992
Tanzania+255
Thailand+66
Timor-Leste+670
Togo+228
Tokelau+690
Tonga+676
Trinidad & Tobago+1
Tunisia+216
Turkey+90
Turkmenistan+993
Turks & Caicos Islands+1
Tuvalu+688
US Virgin Islands+1
Uganda+256
Ukraine+380
United Arab Emirates+971
United Kingdom+44
United States+1
Uruguay+598
Uzbekistan+998
Vanuatu+678
Vatican City+39
Venezuela+58
Vietnam+84
Wallis & Futuna+681
Western Sahara+212
Yemen+967
Zambia+260
Zimbabwe+263
Åland Islands+358

Dog's Information

Name *

Nicknames

Breed *

Gender *

Male
Female

Spayed/Neutered *

Age *

Microchip *

Health

Name of Local Veterinary Clinic *

Veterinary Phone *

United States+1
United Kingdom+44
Afghanistan+93
Albania+355
Algeria+213
American Samoa+1
Andorra+376
Angola+244
Anguilla+1
Antigua & Barbuda+1
Argentina+54
Armenia+374
Aruba+297
Ascension Island+247
Australia+61
Austria+43
Azerbaijan+994
Bahamas+1
Bahrain+973
Bangladesh+880
Barbados+1
Belarus+375
Belgium+32
Belize+501
Benin+229
Bermuda+1
Bhutan+975
Bolivia+591
Bosnia & Herzegovina+387
Botswana+267
Brazil+55
British Indian Ocean Territory+246
British Virgin Islands+1
Brunei+673
Bulgaria+359
Burkina Faso+226
Burundi+257
Cambodia+855
Cameroon+237
Canada+1
Cape Verde+238
Caribbean Netherlands+599
Cayman Islands+1
Central African Republic+236
Chad+235
Chile+56
China+86
Christmas Island+61
Cocos (Keeling) Islands+61
Colombia+57
Comoros+269
Congo - Brazzaville+242
Congo - Kinshasa+243
Cook Islands+682
Costa Rica+506
Croatia+385
Cuba+53
Curaçao+599
Cyprus+357
Czech Republic+420
Côte d’Ivoire+225
Denmark+45
Djibouti+253
Dominica+1
Dominican Republic+1
Ecuador+593
Egypt+20
El Salvador+503
Equatorial Guinea+240
Eritrea+291
Estonia+372
Eswatini+268
Ethiopia+251
Falkland Islands+500
Faroe Islands+298
Fiji+679
Finland+358
France+33
French Guiana+594
French Polynesia+689
Gabon+241
Gambia+220
Georgia+995
Germany+49
Ghana+233
Gibraltar+350
Greece+30
Greenland+299
Grenada+1
Guadeloupe+590
Guam+1
Guatemala+502
Guernsey+44
Guinea+224
Guinea-Bissau+245
Guyana+592
Haiti+509
Honduras+504
Hong Kong+852
Hungary+36
Iceland+354
India+91
Indonesia+62
Iran+98
Iraq+964
Ireland+353
Isle of Man+44
Israel+972
Italy+39
Jamaica+1
Japan+81
Jersey+44
Jordan+962
Kazakhstan+7
Kenya+254
Kiribati+686
Kosovo+383
Kuwait+965
Kyrgyzstan+996
Laos+856
Latvia+371
Lebanon+961
Lesotho+266
Liberia+231
Libya+218
Liechtenstein+423
Lithuania+370
Luxembourg+352
Macau+853
Madagascar+261
Malawi+265
Malaysia+60
Maldives+960
Mali+223
Malta+356
Marshall Islands+692
Martinique+596
Mauritania+222
Mauritius+230
Mayotte+262
Mexico+52
Micronesia+691
Moldova+373
Monaco+377
Mongolia+976
Montenegro+382
Montserrat+1
Morocco+212
Mozambique+258
Myanmar (Burma)+95
Namibia+264
Nauru+674
Nepal+977
Netherlands+31
New Caledonia+687
New Zealand+64
Nicaragua+505
Niger+227
Nigeria+234
Niue+683
Norfolk Island+672
North Korea+850
North Macedonia+389
Northern Mariana Islands+1
Norway+47
Oman+968
Pakistan+92
Palau+680
Palestine+970
Panama+507
Papua New Guinea+675
Paraguay+595
Peru+51
Philippines+63
Poland+48
Portugal+351
Puerto Rico+1
Qatar+974
Romania+40
Russia+7
Rwanda+250
Réunion+262
Samoa+685
San Marino+378
Saudi Arabia+966
Senegal+221
Serbia+381
Seychelles+248
Sierra Leone+232
Singapore+65
Sint Maarten+1
Slovakia+421
Slovenia+386
Solomon Islands+677
Somalia+252
South Africa+27
South Korea+82
South Sudan+211
Spain+34
Sri Lanka+94
St Barthélemy+590
St Helena+290
St Kitts & Nevis+1
St Lucia+1
St Martin+590
St Pierre & Miquelon+508
St Vincent & Grenadines+1
Sudan+249
Suriname+597
Svalbard & Jan Mayen+47
Sweden+46
Switzerland+41
Syria+963
São Tomé & Príncipe+239
Taiwan+886
Tajikistan+992
Tanzania+255
Thailand+66
Timor-Leste+670
Togo+228
Tokelau+690
Tonga+676
Trinidad & Tobago+1
Tunisia+216
Turkey+90
Turkmenistan+993
Turks & Caicos Islands+1
Tuvalu+688
US Virgin Islands+1
Uganda+256
Ukraine+380
United Arab Emirates+971
United Kingdom+44
United States+1
Uruguay+598
Uzbekistan+998
Vanuatu+678
Vatican City+39
Venezuela+58
Vietnam+84
Wallis & Futuna+681
Western Sahara+212
Yemen+967
Zambia+260
Zimbabwe+263
Åland Islands+358

Heartworm Prevention Medication *

Flea/Tick Prevention Medication *

Other Current Medications & Frequency

Medical Conditions (If Applicable)

Diet (Preferences, Sensitivities, Allergies, Digestive Issues)

Is your dog allowed to have dog treats? *

Favorite Dog Treats (If Allowed)

Is your dog allowed to have people food? *

Human foods that are toxic to dogs will never be offered while under our care, including: chocolate, xylitol, alcohol, caffeine, dairy, avocados, grapes/raisins, macadamia nuts, walnuts, onions, and garlic. For more information about dangerous foods for dogs, visit: https://bit.ly/2K0sj2j.

Favorite People Food (If Allowed)

Does your dog like to ride in the car? *

Yes
Not really, but will tolerate it.
No

Does your dog like to have a bath? *

Yes
Not really, but will tolerate it.
No

Favorite Toys & Activities *

Does your dog know any commands or tricks? *

Does your dog have any behavioral issues? (Anxiety, Aggression, Fears, Growling, Biting)

Does Tail Wag Walkers have your permission to post photos of your dog on our website and on social media for promotional purposes? *

Upload a photo of your dog here (optional):

Please add any additional information about your dog that may be helpful for us to know.

Get in Touch by Phone or Email

We would love to help care for your pup. Feel free to call, text, or email us anytime!

Phone / TEXT

(919) 904-0604

Email

info@tailwagwalkers.com