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.
Format: (000) 000-0000.
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
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
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
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
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. All dogs participating in daycare, day school, group classes, or in boarding must be on monthly Flea/Tick preventative and current on rabies vaccinations.
Date
-
Month
-
Day
Year
Date
Submit
Submit
Should be Empty: