VACCINATION RECORD: EQUINE INFLUENZA AND EQUINE HERPES
This form may be used to document Equine Influenza and Equine Herpes Virus (Rhinopneumonitis) vaccinations as defined in USEF GR845.
Owner / Person filling out the form
*
First Name
Last Name
Email of the person filling out this form
*
example@example.com
Horse Name
*
Horse Location
*
Stable, Town, State
Name of Person Administrating the Vaccine
*
First Name
Last Name
Phone # of Person Administering the Vaccine
*
Please enter a valid phone number.
Date of Flu Vaccine
*
-
Month
-
Day
Year
Name of Flu Vaccine
*
For example: Vetera Gold
Batch Number of Vaccine
*
Mode of Administration
*
IM - Intramuscular
IN - Intranasal
Date of Rhino Vaccine
*
-
Month
-
Day
Year
Name of Rhino Vaccine
*
Batch Number
*
Mode of Administration
*
IM - Intramuscular
IN - Intranasal
Please upload the vaccination record/ bill with your vet's letterhead. For those doing their own vaccinations, please take a picture of the receipt and vaccine bottle showing the name & batch number and upload it here
*
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Additional Comments
Your electronic signature will consider the above information as accurate and binding.
Date of Signature
-
Month
-
Day
Year
Submit
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