Untangled Tail Application Form

Thank you for your interest and for taking the time to fill out this application. Submission does not guarantee an appointment.

Page 1 of 4 - Basic Information

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What is your first and last name
Are you a current client or a new client?
What's a good phone number to text you on? What's a good phone number to text you on? - ### - ### ####

We primarily communicate through text!
What's your home address? What's your home address?
Street Address Address Line 2 City State / Province / Region Postal / Zip Code
What is your email address?
How much does your pet weigh (in pounds)

Please note that for new clients we are not accepting dogs over 20 pounds
Is someone other than you authorized to pick up your pet? If yes, please provide the full name of the person authorized to pick up your pet

For the safety of all pets, we will only release pets to individuals listed here unless otherwise instructed.
Please provide the authorized person's phone number
Emergency Contact Info

Please provide the contact information for someone we may reach if we are unable to contact you during your dog’s appointment or in the event of an emergency.
Emergency contact Emergency contact First Last
Emergency contact relationship to owner
Emergency contact phone number Emergency contact phone number - ### - ### ####