Customer & Animal Registration:
For the Purchase of POM-VPS or NFA-VPS Medicines
Street Address Line 2
State / Province
Postal / Zip Code
Would you like one of our SQPs to contact you regarding this order?
About The Animal(s)
What Species Is the Animal
Number of Animals to be Treated
If the animal is an Equine (Horse/Pony/Donkey/Mule) Please confirm if the animal is signed out of the food chain, this means the section is also signed by a Vet in the animals passport.
YES - I confirm the animal is signed out of the food chain and can never be slaughtered for human consumption.
NO - i intend on the animal being used for human consumption
Im not sure
Please list - Age, Weight, Sex for EACH animal to be treated
Are any of the animals to be treated - Pregnant, Nursing or Unwell
If you are ordering a wormer for example, please list down what the last treatment was that you used and when it was last given.
Have you previously administered this product?
Please confirm you are aware of the relevant safety precautions relating to the product, and that you will read the packaging and product literature before using the product, And that if you have any doubt you will contact your Vet or an SQP
Yes - I agree to the above statement.
No - I do not agree
Please Provide the ID of the Animal - (Microchip, Passport No, Herd/Flock Number & Ear Tag Number)
Should be Empty:
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