Wags To Riches

New Customer Form

Welcome to our new customer form that Wags To Riches requires for all new clients. We welcome you to complete this form online so that it will be on record when you come into the shop. If no form is on file you will have to complete this form on your first visit.

General Information

First Name*
Last Name*
Address*
City*
State*
Zip*
Home Phone
Cell Phone*
Work Phone
Email*
Referred By
Alternative Contact Information


We will contact this person in the event we can't reach you.
First Name*
Last Name*
Phone Number*
Pet Information

Pet Name*
Breed*
Color*
Weight*
Lbs
Male/Female*
 Male Female
Neutered/Spayed*
 Yes No
Shots*
 Yes No
Birthday
Age*
Medical Information

Veterinarian
Doctor
Phone Number
Medical Conditions
Additional Information
Additional Notes
Acknowledgement

Initials*

By initaling this document you acknowledge the information on this document is correct
to the best of your knowledge.

* Required Feilds