RCAC Vaccine Clinic Information Form
Please fill out the form below if this is your first time at RCAC. If you have been here before but you need to update your information, or add a new pet, please fill out the form below.
Have you ever been to RCAC before?
No, I need to fill out this form for each one of my pets.
Yes, but I have a new pet.
Yes, But my personal information needs to be updated.
Yes, all mine, and my pets information is up to date.
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Your Name
*
First Name
Last Name
E-mail
*
Phone Number
*
Format: (000) 000-0000.
How did you find out about us?
*
Family/friend
Internet
RCAC walk-in clinic
Other animal hospital
Rochester Animal Services
Lollypop Farm
Rescue group
Groomer
Other
Address
*
Street Address
Apartment or Building Number
City
State / Province
Postal / Zip Code
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About your Pet
Pet's Name
*
What kind of pet?
*
Dog
Cat
What breed is your pet?
Date of Birth
-
Month
-
Day
Year
Date
Estimated age
*
Primary color
*
Apricot
Beige
Black
Blonde
Blue
Brown
Chestnut
Chocolate
Copper
Cream
Fawn
Gold
Grey
Liver
Red
Sable
Silver
Wheaten
White
Tan
Yellow
Secondary Color
Apricot
Beige
Black
Blonde
Blue
Brown
Chestnut
Chocolate
Copper
Cream
Fawn
Gold
Grey
Liver
Red
Sable
Silver
Wheaten
White
Tan
Yellow
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Sex
*
Male
Female
Is your pet spayed or neutered?
*
Yes
No
Has this Pet ever been to the vet before?
*
Yes
No
Please attach photo copy or PDF of previous vaccination records here:
Upload a File
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Please select the Vaccine you would like your cat to receive at the appointment:
Rabies Vaccine - This is a core vaccine required by law for all dogs, cats, and ferrets in New York State.
FVRCP Vaccine - This is a core vaccine which protects cats from several contagious, viral respiratory and GI diseases, including "kitty parvo"
Feline Leukemia Vaccine - Recommended for cats that go outside or frequently come into contact with other cats (cats may need to be tested for Feline Leukemia Virus prior to receiving vaccines)
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Please select the services you would like your dog to received during the vaccine clinic:
Rabies vaccine - This is a core vaccine required by law for all dogs, and cats in New York State. - $25
DHPP/DHLPP vaccine -This is a core vaccine which protects dogs from parvo and several other contagious diseases. The Lepto portion of the vaccine is recommended to dogs that are old and large enough. - $25
Lyme - Protects dogs from Lyme disease usually contracted from ticks. If your dog doesn't go outside often, especially in the woods, you do not need this vaccine. $30
Kennal Cough- this vaccine is more of a lifestyle choice. are you planning on going to the dog park, Groomer, or kennal for daycare or overnight care? you will need this vaccine. - $25
Lepto- Another lifestyle vaccine to protect your dog from leptospirosis. Commonly found in puddles if a wild life urinated in. Does your dog not go outside or in puddles? you do not need this vaccine. -$25
We cant wait to see you there!
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Thanks for keeping your information up to date!You don’t need to complete this form. We hope to see you there!
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