Canine Vaccination Drive
Hornby Veterinary Centre Saturday December 6th 12pm-2pm. Once registered you will be contacted to confirm your 5 minute slot.
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
example@example.com
Phone Number
-
Area Code
Phone Number
Dog 1 Name
Dog 1 Age
Dog 1 Sex (male/female)
Dog 2 Name
Dog 2 Age
Dog 2 Sex (male/female)
Please provide any additional information on your dog including if your dog is friendly or if it may need a muzzle for its vaccination.
Please attached proof of eligibility e.g Community services card, letter from WINZ, letter from SPCA, letter from Chch council
Browse Files
Cancel
of
Approx. date of my dogs last vac if known/if previously vaccinated
I am the owner of the above animal/s
I agree
I am over the age of 18 or will be accompanied by a parent/legal gaurdian
I agree
I understand that the above animal will not have a health check prior to the administration of the vaccination.
I agree
I understand that this is not a consultation with the veterinarian or veterinary nurse.
I agree
I understand that this vaccination may need a booster administered in 3-4 weeks time and I am to take full responsibility in arranging an appointment for this at my chosen veterinary clinic.
I agree
I understand that the administration of a vaccination without a general health check may have a greater risk of adverse reactions. If my dog experiences any adverse reactions I will eek the help of my chosen veterinary clinic
I agree
I confirm my dog does not currently have vomiting, diarrhea, coughing or sneezing
I agree
I understand that I need to leave my dog in my car until instructed otherwise
I agree
If the animal is not suitably restrained and shows aggression that may effect the well being of our staff we will be unable to administer the vaccination
I agree
I consent to the parvovirus vaccination being administered on the 6th December
I agree
Signature
Continue
Continue
Hornby Veterinary Centre will be in touch to confirm your time slot.
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