Rabies Vaccination Certificate
Microchip ID:
Vaccine Tag ID:
Pet Owner's Name:
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Animal Name:
Sex:
Species:
Spay/Neuter:
Age/DOB:
Size:
Breed:
Color:
SERVICES REQUESTED DURING EVENT:
DHPPV – Core combination vaccine for dogs that protects against distempter, hepatitis, parvovirus and parainfluenza.
BORDETELLA – Protects against Bordetellosis (kennel cough)
RABIES-Protects against Rabies virus and is required by Texas Law
MICROCHIP- Required by city ordinance and helps protect your pet should they get lost.
I acknowledge that receiving vaccinations for my pet comes with potential adverse side effects. I understand that any reaction that occurs is a result of my pet's own immune system and is not the fault of Concho Valley PAWS nor the veterinarian or technician administering the vaccines. I understand that it is my financial responsibility to seek medical treatment of any such reactions.
Signature:
DATE VACCINATED:
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Month
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Day
Year
Date
VACCINE EXPRIRATION DATE
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Month
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Day
Year
Date
Product Name
Manufacturer
Vaccine Serial No.
Rabies Vaccine
Zoetis
Rows
Veterinarian License
Veterinarian Signature
Dr. Theresa Feller
Dr. Ashley Dierschke
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