That Muddy Mutt | New Client Registration Form

The form below is for new clients only. If you're already a client of That Muddy Mutt, please click here to request an appointment.

That Muddy Mutt New Client Registration Form

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We are so excited to have you as part of That Muddy Mutt family! Please fill out the form below. We will email you a waiver to e-Sign once we receive your information.

Owner Information

First Name *Required*

Last Name *Required*

Phone Number *Required*

Email *Required*

Address *Required*

City *Required*

State | Province *Required*

Zip Code | Postal Code *Required*

Family Vet Clinic *Required*

How did you find us? *Required*

Emergency Contact (Include Phone Number)/Others Allowed to Pick Up *Required*

Owner Question #1: Do you want text reminders about appointments? *Required*

Pet #1 Information

Pet Name *Required*

Breed (Best Guess) *Required*

Sex *Required*

Color Description *Required*

Date of Birth *Required*

Important: Vaccines Required for all services at That Muddy Mutt. This is for the health and safety of all the beloved pets we care for and about.

Rabies Expiration *Req*

DA2PP Expiration *Req*

Bordetella Expiration *Req*

Microchip Code

Weight *Required*

Insurance Info

Feeding Notes *Required*

Medication Notes *Required*

Temperament Notes (Aggression, anxiety, etc? If extensive, tell us in person).

Additional Notes (Anything else we should know? If extensive, tell us in person.) *Req*

Mobile Phone Alert: Some phones have difficulty uploading the files below (the form gets reset after uploading). If this happens on your phone, please submit this form using a computer. You can also submit this form on your phone without uploading anything and then email your pet picture and vaccine verification document to us at thatmuddymutt@gmail.com. Thanks!

Pet Photo (Not Required. 5MB Max. Image Files Only)
Click to Upload Pet Picture

Proof of Vaccinations (5MB Max. Only Images, No PDFs. Take a Picture of Document with Your Phone and Upload It.)

Click to Upload a Picture of Proof of Vaccinations

Click Here to Add a Second Pet

Click Here to Add a Third Pet

ALERT: If you have more than three pets, submit this form once with your first three pets. After submitting the first time, click the link to come back to the form (shown after you submit the form) and fill out this form again with the information for your other pets. The second time you fill it out, you only need to include your name, phone and email in the OWNER section because the business will already have the other info (address, emergency contact, etc) from the first time you submitted the form.

Pet #3 Information