Owner & Pet Information

Complete one form for your household. Add as many pets, horses, or livestock animals as needed.

Privacy: Your information is submitted to Wix Forms for Wags and Wiggles to review; it is not displayed on the website. Do not enter alarm codes, door codes, passwords, or payment details. Arrange secure access separately.

Owner and emergency contacts

Owner full name *Email address *Phone number *Service addressEmergency contact name and phoneVeterinarian name and phoneAccess arrangements (do not include passwords or codes)

Animals in your care

Emergency veterinary authorization

If I cannot be reached, I authorize Wags and Wiggles to: *

This choice is recorded exactly as selected. Any costs and treatment decisions remain subject to applicable law and veterinary requirements.

General household or livestock care notes

Owner consent and electronic signature

By signing, I confirm that the information provided is accurate to the best of my knowledge and that my veterinary authorization choice above reflects my instructions. I understand this form does not authorize automatic payments or refunds.

I am the owner or authorized caregiver and agree to sign this form electronically. *Type your full legal name as your electronic signature *Date signed *

Questions? Call 814-242-8137.