Dog Health Certification
Documents required for all services.
Dog Owner's Name
*
First Name
Last Name
Dog's Name
*
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Dog's Breed
*
Age
*
Sex
*
Female
Male
Neuter/Spay?
*
Yes, is Neutered/Spayed
No, Intact Animal
Dog 's Primary Veterinarian
Clinic Name
Phone Number (Optional)
Is your dog current on the Rabies vaccination?
*
Please Select
Yes, 1 year shot
Yes, 3 year shot
No, Puppy under 6 months
No, dog/puppy over 6 months
Upload proof below or email to ABQK9VAX@gmail.com
Upload Rabies Certificate
*
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REQUIRED Vaccinations/Preventatives & Medications
*
Distemper Vaccination
Parvo Vaccinations (3+ rounds)
Bordetella Vaccination
Flea/Tick Prevention
Heartworm Medication
Vaccination/Prevention Dates:
*
Example: Flea/Tick and Heartguard given 4/15/2024
Upload Other Vaccinations/Prevention/Medication
*
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My dog is healthy and free from all parasites and communicable conditions or diseases?
*
Please Select
Yes
No
Owner's Signature
*
By signing here I certify that my dog is healthy and free from all parasites and communicable conditions or diseases. I certify that they are current on all state mandated vaccinations including Rabies. We recommend staying current on Distemper, Parvo, Bordetella, and the appropriate preventatives such as heartworm and flea/tick medications. I understand if I have not kept my dog current on all recommended and required vaccinations, it is at my own risk and my dog's risk.
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Month
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