Vaccine Clinic Registration

Vaccine Clinic Registration

Date of Clinic: 9-6-25

Location: Ultimate Doggie Destination
Philadelphia Premium Outlets, 18 Lightcap Rd, Pottstown, PA 19464

For easy access park behind Nike

We cannot accept feral cats at the vaccine clinic.

All aggressive dogs must be muzzled before arriving at the vaccine clinic.

Pet Owner Name*

First NameLast Name

Email*

example@example.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Area Code and Phone Number *

Appointment Time Slot*

PET(S) Information

IMPORTANT - PLEASE READ BEFORE CONTINUING

This section must be filled out completely and correctly.

Failure to follow these instuctions will cause delays, invalid paperwork, and longer wait times for everyone.

Arrive at your appointment time - NOT early. You will not be signed in until your appointment time.

Pet(s) Name: Spell it how you want it on your documents we will not correct spelling

Dog or Cat: DO NOT LEAVE BLANK

Spayed/Neutered: Yes or No

If your dog/cat is spayed or neutered, enter YES.
If not, enter NO.

Breed (required):

Dogs: Do NOT write “mixed.” Instead, list the predominant breed, followed by “mix” (e.g., Lab mix).

Cats: Do not leave blank. Typical cat breed entries are:

DSH (Domestic Short Hair)
DLH (Domestic Long Hair)
or the specific purebred breed

Rabies: 1 or 3

If your dog/cat is getting a Rabies Vaccine, enter 1 for 1-year or 3 for 3-year
If not, enter NO.

If you are unsure about how to fill out this form or have questions, PLEASE email vaccine.clinic@ddpets.com. I'm happy to help ensure your pet is gets the right care.

Is your pet(s) getting a Rabies Vaccine at this clinic?*

YESNO

Proof of Rabies ONLY if your pet is getting a 3-year Rabies Vaccine

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PET(S) Information: List all pets getting vaccines. Do not make separate appointments! *

	Pet Name	Dog or Cat	Age Years or Months	Predominant Breed	Color	Gender M or F	Spayed/Neutered YES or NO	Weight: Under 20lbs. 20-50 Over 50	Rabies: 1 or 3
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.

Dog: Vaccine Recommendation

Cat: Vaccine Recommendation

We cannot vaccinate pets that have had a previous reaction to a vaccination. Owner is financially responsible for any vaccination reactions. Who to call in the case of an Emergency: Pottstown Urgent Vet. #484-763-4500 Metropolitan Emergency Service (610) 666-0914 or Veterinary Referral Center (610) 647-2950*

I understand

Upload an Active Prescription/Proof of a Heartworm test within the last 12 months for purchase of RX items.

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SERVICES AND QUANTIY

Services

DOG VACCINES
product

Rabies Vaccine: 3 yr. or 1 yr. $22.00

Rabies is a 3 yr. vaccine, unless it is your pet's first vaccine. *You must provide paper proof (tags on collars are not legal proof) of a previous rabies vaccine in order to have a 3 yr. rabies certificate issued. Recommended for healthy dogs/cats 12 weeks of age or older.

Quantity

Nobivac® Canine DAPPvL2 Vaccine for Dogs (7-way)$10.00

(Sale reg. price $19) Nobivac® Canine 1-DAPPvL2, has been shown to be effective for vaccination of healthy dogs 6 weeks of age or older against canine distemper virus, canine adenovirus type 1 (hepatitis), canine adenovirus type 2 (respiratory disease), canine parainfluenza virus, canine parvovirus, Leptospira canicola and Leptospira icterohaemorrhagiae. Recommended for healthy dogs 6 weeks of age or older. Two doses given 2-4 weeks apart -Repeat at 2–4-week intervals until the dog is 12 weeks of age -Annual revaccination with 1 dose is recommended

Quantity

Canine Combo (6 in 1) DA2PPv+CV$26.00

(dog) DAPPV+CV =Canine Distemper Virus, Canine Adenovirus type 1 and 2, Canine Parainfluenza Virus, Canine Parvovirus (modified live viruses), Coronavirus (inactivated virus). Recommended for healthy dogs 6 weeks of age or older. Two doses given 2-4 weeks apart -Repeat at 2-4 week intervals until the dog is 12 weeks of age -Annual revaccination with 1 dose is recommended

Quantity

Canine Combo with Lepto (8 in 1) DAPPvL2+Cv$29.00

(dog) Canine Distemper Virus, Canine Adenovirus type 1 & 2, Canine Parainfluenza Virus, Canine Parvovirus (modified live viruses), Coronavirus (inactivated virus) and Leptospira Canicola-Icterohaemorrhagiae(inactivated bacterin). Recommended for healthy dogs 6 weeks of age or older. Two doses given 2-4 weeks apart -Repeat at 2-4 week intervals until the dog is 12 weeks of age -Annual revaccination with 1 dose is recommended

Quantity

Small Canine Combo (5 in 1) EDGE® DAPPv+L4$26.00

(dog) This vaccines .5 ml dose is half the volume of a normal vaccine making it ideal for small breed dogs. For use in healthy dogs 8 weeks of age and older repeated in 2-4 weeks. This vaccine is Thimerosal free and uses VacciPure™ filtration technology making it 99% reaction-free. It protects against Canine Distemper Virus, Canine Adenovirus Type 2, Canine Parainfluenza Virus, Canine Parvovirus (modified live viruses), Leptospira Canicola- Icterohaemorrhagiae, L. Pomona and L. Grippotyphosa.

Quantity

Leptospirosis 4 $21.00

(dog) NOBIVAC LEPTO4 - four-way leptospirosis vaccine - Recommended for healthy dogs 8 weeks of age or older. 2 Doses given 2-4 weeks apart - Annual vaccination recommended

Quantity

Bordetella (Kennel Cough Oral)$21.00

(dog) NOBIVAC® INTRA-TRAC® ORAL This product has been shown to be effective for vaccination of healthy dogs 7 weeks of age or older against Bordetella bronchiseptica. Annual revaccination is recommended.

Quantity

Nobivac® NXT Canine Flu H3N2$29.00

The H3N2 strain of canine influenza continues to be a concern, while the H3N8 strain has been considered “eradicated" in the USA since 2017. The first and only canine influenza vaccine utilizing RNA particle technology is available in a low-volume dose of 0.5 mL, providing a gentler vaccination experience. Healthy dogs aged 8 weeks and older require two doses of the vaccine, which should be administered three to four weeks apart. The necessity for annual boosters is still undetermined.

Quantity

Lyme Vaccine $38.00

(Sale reg. price $42) Recommended for healthy dogs 8 weeks of age or older. Two doses given 2 to 4 weeks apart Annual revaccination with 1 dose is recommended.

Quantity

DOG TESTS
product

Heartworm/Lyme/Erlichia/A.Platys (4DX)$40.00

(dog) Begin testing dogs at 6 months of age, annual to every 6 months testing is recommended. Even dogs that receive year-round tick control and prevention are at a high-risk for exposure to tick-borne diseases. This is the test most recommended for our area.

Quantity

Heartworm Test $28.00

(dog) Annual testing recommended All dogs greater than 6 months of age should be tested.

Quantity

HEARTWORM PREVENTION + FLEA/TICK
product

Simparica Trio 5.6-11 lbs. Dogs, 1 Month Supply$29.00

Simparica Trio is a once-a-month chewable that protects your dog against heartworm disease, ticks & fleas, roundworms & hookworms. FDA-approved to block infections that may cause Lyme disease by killing deer ticks. RX This item requires an active prescription or proof of a HW test within the last 12 months.

Quantity

Simparica Trio 5.6-11 lbs. Dogs, 6 Month Supply $165.00

Simparica Trio is a once-a-month chewable that protects your dog against heartworm disease, ticks & fleas, roundworms & hookworms. FDA-approved to block infections that may cause Lyme disease by killing deer ticks. RX This item requires an active prescription or proof of a HW test within the last 12 months.

Quantity

Simparica Trio 11.1-22 lbs. Dogs, 1 Month Supply$31.00

Simparica Trio is a once-a-month chewable that protects your dog against heartworm disease, ticks & fleas, roundworms & hookworms. FDA-approved to block infections that may cause Lyme disease by killing deer ticks. RX This item requires an active prescription or proof of a HW test within the last 12 months.

Quantity

Simparica Trio 11.1-22 lbs. Dogs, 6 Month Supply $176.00

Simparica Trio is a once-a-month chewable that protects your dog against heartworm disease, ticks & fleas, roundworms & hookworms. FDA-approved to block infections that may cause Lyme disease by killing deer ticks. RX This item requires an active prescription or proof of a HW test within the last 12 months.

Quantity

Simparica Trio 22.1-44 lbs. Dogs, 1 Month Supply$32.00

Simparica Trio is a once-a-month chewable that protects your dog against heartworm disease, ticks & fleas, roundworms & hookworms. FDA-approved to block infections that may cause Lyme disease by killing deer ticks. RX This item requires an active prescription or proof of a HW test within the last 12 months.

Quantity

Simparica Trio 22.1-44 lbs. Dogs, 6 Month Supply $186.00

Simparica Trio is a once-a-month chewable that protects your dog against heartworm disease, ticks & fleas, roundworms & hookworms. FDA-approved to block infections that may cause Lyme disease by killing deer ticks. RX This item requires an active prescription or proof of a HW test within the last 12 months.

Quantity

Simparica Trio 44.1-88 lbs. Dogs, 1 Month Supply$34.00

Simparica Trio is a once-a-month chewable that protects your dog against heartworm disease, ticks & fleas, roundworms & hookworms. FDA-approved to block infections that may cause Lyme disease by killing deer ticks. RX This item requires an active prescription or proof of a HW test within the last 12 months.

Quantity

Simparica Trio 44.1-88 lbs. Dogs, 6 Month Supply $195.00

Simparica Trio is a once-a-month chewable that protects your dog against heartworm disease, ticks & fleas, roundworms & hookworms. FDA-approved to block infections that may cause Lyme disease by killing deer ticks. RX This item requires an active prescription or proof of a HW test within the last 12 months.

Quantity

Sentinel Spectrum Chew for Dogs, 2-8 lbs, (Orange Box), 6 Chews (6-mos. supply)$45.00

SENTINEL SPECTRUM is a monthly oral preventive prescription that protects your pet against heartworms, adult roundworms, adult hookworms, whipworms, and prevents the development of flea eggs. RX This item requires an active prescription or proof of a HW test within the last 12 months.

Quantity

Sentinel Spectrum Chew for Dogs, 8.1-25 lbs, (Green Box), 6 Chews (6-mos. supply)$46.00

SENTINEL SPECTRUM is a monthly oral preventive prescription that protects your pet against heartworms, adult roundworms, adult hookworms, whipworms, and prevents the development of flea eggs. RX This item requires an active prescription or proof of a HW test within the last 12 months.

Quantity

Sentinel Spectrum Chew for Dogs, 50.1-100 lbs, (Blue Box), 6 Chews (6-mos. supply)$54.00

SENTINEL SPECTRUM is a monthly oral preventive prescription that protects your pet against heartworms, adult roundworms, adult hookworms, whipworms, and prevents the development of flea eggs. RX This item requires an active prescription or proof of a HW test within the last 12 months.

Quantity

Selarid Topical for Puppies & Kittens, 0-5 lbs. (single dose) $11.00

Selarid is recommended for use in dogs six weeks of age or older and cats eight weeks of age and older for the following parasites and indications: Dogs: Kills adult fleas and prevents flea eggs from hatching for one month and is indicated for the prevention of heartworm disease, treatment and control of ear mite infestations, treatment and control of sarcoptic mange and for the control of tick infestations. Cats: Kills adult fleas and prevents flea eggs from hatching for one month and is indicated for the prevention of heartworm disease, treatment and control of ear mite infestations and roundworm and hookworm infections in cats.

Quantity

Selarid Topical Solution for Cats, 5.1-15 lbs. (single dose)$12.00

Selarid is recommended for use in cats eight weeks of age and older. Selarid kills adult fleas and prevents flea eggs from hatching for one month, prevention of heartworm disease, treatment and control of ear mite infestations and for the treatment and control of roundworm and intestinal hookworm infections.

Quantity

Iverhart Plus Flavored Chewable for Dogs up to 25 lbs. BLUE (single dose)$5.00

Iverhart Plus Flavored Chewables, when given monthly, can protect your dog from heartworm disease as well as treat and control roundworms and hookworms. Iverhart Plus chewable tablets are tasty and safe, even for puppies as young as 6 weeks of age. RX This item requires an active prescription or proof of a HW test within the last 12 months.

Quantity

Iverhart Plus Flavored Chewable for Dogs up to 25 lbs. BLUE (6 Month Supply)$27.00

Iverhart Plus Flavored Chewables, when given monthly, can protect your dog from heartworm disease as well as treat and control roundworms and hookworms. Iverhart Plus chewable tablets are tasty and safe, even for puppies as young as 6 weeks of age. RX This item requires an active prescription or proof of a HW test within the last 12 months.

Quantity

Iverhart Plus Flavored Chewable for Dogs 26 to 50 lbs. GREEN (single dose) $7.00

Iverhart Plus Flavored Chewables, when given monthly, can protect your dog from heartworm disease as well as treat and control roundworms and hookworms. Iverhart Plus chewable tablets are tasty and safe, even for puppies as young as 6 weeks of age. RX This item requires an active prescription or proof of a HW test within the last 12 months.

Quantity

Iverhart Plus Flavored Chewable for Dogs 26 to 50 lbs. GREEN (6 month supply)$37.00

Iverhart Plus Flavored Chewables, when given monthly, can protect your dog from heartworm disease as well as treat and control roundworms and hookworms. Iverhart Plus chewable tablets are tasty and safe, even for puppies as young as 6 weeks of age. RX This item requires an active prescription or proof of a HW test within the last 12 months.

Quantity

Iverhart Plus Flavored Chewable for Dogs 50 to 100 lbs. BROWN (single dose)$9.00

Iverhart Plus Flavored Chewables, when given monthly, can protect your dog from heartworm disease as well as treat and control roundworms and hookworms. Iverhart Plus chewable tablets are tasty and safe, even for puppies as young as 6 weeks of age. RX This item requires an active prescription or proof of a HW test within the last 12 months.

Quantity

Iverhart Plus Flavored Chewable for Dogs 50 to 100 lbs. BROWN (6 Month Supply)$48.50

Iverhart Plus Flavored Chewables, when given monthly, can protect your dog from heartworm disease as well as treat and control roundworms and hookworms. Iverhart Plus chewable tablets are tasty and safe, even for puppies as young as 6 weeks of age. RX This item requires an active prescription or proof of a HW test within the last 12 months.

Quantity

FLEA & TICK DOG & CAT
product

BRAVECTO Topical for Dogs 4.4-9.9 lbs. (Yellow Box)$29.00