Intake Form Pet Transportation

Name *

Email address *

Phone number *

Home Address *

Pet(s) name *

Species/Breed *

Age *

Weight *

Sex *

Spayed/Neutered *

Microchipped *

Vaccinations Up to Date *

Any medical conditions? *

Any medications? (Include dosage & schedule) *

Behavioral notes (anxiety, reactivity, high‑energy, special handling needs) *

Pickup Address *

Preferred Pickup Date & Time *

Contact Person at Pickup (if different from owner) *

Special instructions for pickup (gate codes, parking, preferred handling) *

Drop‑Off Address *

Contact Person at Drop‑Off: *

Special instructions for drop‑off: *

Approximate wait time if applicable *

Does your pet require frequent breaks? *

Feeding instructions during transport (if applicable) *

Harness provided? Yes / No *

Emergency Contact *

Emergency Contact Phone *

Veterinary Clinic Name *

Veterinary Clinic Phone *

Permission to seek emergency veterinary care if needed: Yes / No *

Owner Agreement By submitting this form, I confirm that the information provided is accurate. I understand that The Bark Wagon is USDA‑certified, operates a climate‑controlled Chevy Blazer EV, and prioritizes safe, humane transport. I agree to all transport policies and acknowledge that unexpected behavior or medical needs may require adjustments during travel.

Signature (typed name) *

Date *