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Dog Vaccines
Vaccine Clinic
Time
Hour Minutes
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PM
AM/PM Option
Vehicle Make/color
New or Existing Client
Existing
New
Required General Health questions, Please check if the answer is YES.
Is your pet pregnant?
Is your pet anxious or will bite?
Is your pet ill, coughing, sneezing, vomiting, diarrhea?
Does your pet have vaccine reactions?
I certify that my pet is healthy, eating and drinking in the past 7 days.
*
Last
*
First
*
Home Address
*
Street Address
City
State
Zip Code
Home Phone
Cell Phone
*
ACCURATE EMAIL REQUIRED to email your Rabies Certificate
*
example@example.com
Pet's Name
*
Color
*
Breed
*
Sex
*
Please Select
Female
Female Spayed
Male
Male Neutered
Litter
Birthdate
*
-
Month
-
Day
Year
Age of pet
Choose your vaccine by checking the box on the left.
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Adult Dog Package
Adult DHPPC, Bordetella, Rabies package
$
60.00
Quantity
1
Length of Vaccine
3 Year - Pet over 1 year
Rabies
Dogs minimum 16 weeks or older. Required for licensing in our area.
$
10.00
Quantity
1
Length of Vaccine
1 Year - Pet less than 1 year
3 Year - Pet over 1 year
Parvovirus ONLY
For puppies 6-7 weeks.
$
19.00
Quantity
1
2
3
4
5
6
7
8
9
10
Puppy Series Deworm
Broad spectrum for round, hook, whipworms Not for tape worms. For puppies ONLY, every 3 weeks, aged 8-20 weeks.
$
24.00
Quantity
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
Series Details
Deworm #1
Deworm #2
Deworm #3
Deworm #4 Series Final
Puppy Series DHPPC
Distemper, Hepatitis, Parainfluenza, Parvovirus, Coronavirus. For puppies ONLY, every 3 weeks, aged 8-20 weeks.
$
26.00
Quantity
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
Series Details
DHPPC #1
DHPPC #2
DHPPC #3
DHPPC #4 Series Final
Adult DHPPC
Distemper, Hepatitis, Parainfluenza, Parvovirus, Coronavirus. Annual Booster.
$
26.00
Quantity
1
Adult Deworm
Broad spectrum for round, hook, whipworms Not for tape worms.
$
24.00
Quantity
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
Adult Bordetella
Kennel cough vaccine. Single Dose, Annual Booster. Minimum 12 weeks of age.
$
20.00
Quantity
1
Lyme Disease
Tick Born Disease, can be spread to Humans. 2 Doses initially required. Annual Booster. Minimum 12 weeks of age.
$
35.00
Quantity
1
Rattlesnake Vaccine
Helps increase chance of survival 2 Doses initially required. Annual Booster. Minimum 16 weeks.
$
30.00
Quantity
1
Canine Influenza
Canine Influenza is spread by Dog to Dog contact. It is given in 2 Doses initially, Annual Booster. Minimum 12 weeks of age.
$
35.00
Quantity
1
2
3
4
5
6
7
8
9
10
Series Details
3 Weeks
Annual
Microchip
Microchip insertion and online registration package.
$
55.00
Please upload any available Vaccine records and a profile pic of your pet.
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Payment Type
Credit/Debit
Cash
Care Credit
Cashier Name
Adrian
Alize
Ariana A
Ariana I
Brianna
Lizbet
Lynda
Status
Paid
Not Complete
Vaccinator Name
Alize
Dulce
Gabby
Jennifer
Lynda
Patty
Other
Office Use only
Rabies Tag #
Vaccine Process
Complete
Not Complete
Comments
Data Entry
Adrian
Alia
Alize
Ariana
Briellah
Jazmin
Jennifer
Lynda
Other
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