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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.
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Last
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First
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Home Address
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Street Address
City
State
Zip Code
Home Phone
Cell Phone
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ACCURATE EMAIL REQUIRED to email your Rabies and Vaccine Certificates within THREE business days
*
example@example.com
Pet's Name
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Color
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Breed
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Sex
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Please Select
Female
Female Spayed
Male
Male Neutered
Litter
Birthdate
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Month
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Day
Year
Age of pet
Choose your vaccine by checking the box on the left.
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Bordetella Adult Annual
Kennel cough vaccine, often required by groomers and boarding facilities. Single Dose, Annual Booster. Minimum 12 weeks of age.
$
20.00
Quantity
1
DHPPC Adult Annual
Distemper, Hepatitis, Parainfluenza, Parvovirus, Coronavirus. Annual Booster.
$
26.00
Quantity
1
Deworm Adult Annual
Basic Broad spectrum for round, hook, whipworms. NOT FOR TAPE WORMS (must be treated by appointment inside).
$
24.00
Quantity
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
Influenza Adult Annual
Canine Influenza is spread by Dog to Dog contact, often required by groomers and boarding facilities. 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
Lyme Adult Annual
Tick Born Disease, can be spread to Humans. 2 Doses initially required. Annual Booster. Minimum 12 weeks of age.
$
35.00
Quantity
1
Rabies (1 Year) - Pet is receiving first Rabies vaccine in their lifetime.
Dog minimum 16 weeks or dog not previously vaccinated for Rabies. Required for licensing in our area.
$
10.00
Quantity
1
Rabies (3 Year) - Pet has received at least one prior Rabies vaccine in their lifetime.
Dog previously vaccinated for Rabies. Required for licensing in our area.
$
10.00
Quantity
1
Rattlesnake Initial Dose - Pet is receiving first Rattlesnake vaccine in their lifetime.
Dog minimum 16 weeks or dog not previously vaccinated for Rattlesnake. Helps increase chance of survival.
$
30.00
Quantity
1
Rattlesnake Adult Annual - Pet has received at least one prior Rattlesnake vaccine in their lifetime.
Helps increase chance of survival. Annual Booster.
$
30.00
Quantity
1
Puppy Bordetella Annual
Kennel cough vaccine, often required by groomers and boarding facilities. Single Dose, Annual Booster. Minimum 12 weeks of age.
$
20.00
Quantity
1
Puppy Influenza Series
Canine Influenza is spread by Dog to Dog contact, often required by groomers and boarding facilities. 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
Puppy Parvovirus ONLY
For puppies 6-7 weeks.
$
19.00
Quantity
1
2
3
4
5
6
7
8
9
10
Puppy Deworm Series
Basic Broad spectrum for round, hook, whipworms, NOT FOR TAPE WORMS (must be treated by appointment inside). 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 DHPPC Series
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
Puppy Lyme Initial Dose
Tick Born Disease, can be spread to Humans. 2 Doses initially required. Annual Booster. Minimum 12 weeks of age.
$
35.00
Quantity
1
Puppy Lyme Annual Dose
Tick Born Disease, can be spread to Humans. 2 Doses initially required. Annual Booster. Minimum 12 weeks of age.
$
35.00
Quantity
1
Puppy Rattlesnake Initial Dose - Pet is receiving first Rattlesnake vaccine in their lifetime.
Dog minimum 16 weeks or not previously vaccinated for Rattlesnake. 2 Doses initially required: Initial + Annual Booster. Minimum 16 weeks.
$
30.00
Quantity
1
Puppy Rattlesnake Annual (1 Year) - Pet has received first Rattlesnake vaccine.
Helps increase chance of survival. Initial + Annual Booster. Minimum 16 weeks.
$
30.00
Quantity
1
Microchip
Microchip insertion and online registration package.
$
55.00
Payment Type
Credit/Debit
Cash
Care Credit
Please upload any available Vaccine records and a profile pic of your pet.
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Cashier Name
Ariana A
Karen
Lizbet
Erica
Flor
Kaelyn
Prya
Other
Status
Paid
Not Complete
Office Use only
Rabies Tag #
Comments
Data Entry
Alia
Ariana
Briellah
Evelyn
Karen
Marisol
Other
Should be Empty: