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Name of Clinic Here

Logo Here

Address

(if wanted)

 

Phone

 

PROOF OF VACCINATION FORM

 

 

 

 

 

 

 

 

 

 

 

 

File No.

 

 

 

Pet Owner’s Name:

 

 

 

 

 

 

 

Phone No.:

 

 

 

Pet Owner’s Address:

 

 

 

 

 

 

 

 

 

 

 

 

Pet’s Name:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Species:

 

 

Dog

Cat

Other

 

Breed:

 

 

 

 

Color:

 

 

Sex:

Male

Female

 

Spayed/Neutered:

Yes

No

DOB:

 

This animal has been vaccinated for:

Dogs:

DHPP

Bordatella

Rabies

Leptosporosis

Lyme

Date:

 

Date Expires:

Date:

 

Date Expires:

Date:

 

Date Expires:

Date:

 

Date Expires:

Date:

 

Date Expires:

Cats:

FVRCP

Rabies

Feline Leukemia.

Date:

 

Date Expires:

Date:

 

Date Expires:

Date:

 

Date Expires:

 

I certify that (pet’s name)

 

is current on the vaccinations checked above.

 

 

 

 

 

 

 

Veterinarian Signature

 

Date

 

 

 

NOTES:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Copyright 2006 Forms in Word (www.formsinword.com). For individual clinic use only.

Document Information

Fact Name Description
Purpose The Proof of Vaccination Dog form certifies that a pet is up-to-date on its vaccinations, which is essential for public health and pet safety.
Required Information This form requires details such as the pet owner's name, contact information, and the pet's vaccination history, including dates and types of vaccines received.
State Regulations In many states, such as California, the law mandates that dogs receive certain vaccinations, including rabies, to ensure community health.
Veterinarian Certification A licensed veterinarian must sign the form, confirming that the vaccinations listed are current and valid.

Proof Of Vaccination Dog - Usage Guidelines

Completing the Proof of Vaccination Dog form is essential for documenting your pet's vaccination history. This form will require specific information about both the pet owner and the pet, as well as details about the vaccinations received. Follow the steps below to ensure that you fill out the form correctly.

  1. Start by entering the Name of Clinic at the top of the form.
  2. If desired, include the Logo of the clinic next to the name.
  3. Fill in the Address of the clinic, if applicable.
  4. Provide the Phone number of the clinic.
  5. Next, write your Pet Owner’s Name in the designated space.
  6. Enter your Phone No. to ensure you can be contacted if necessary.
  7. Fill in your Pet Owner’s Address for record-keeping purposes.
  8. Write your pet’s Name in the appropriate section.
  9. Select the Species of your pet by marking the correct option (Dog, Cat, Other).
  10. Indicate your pet’s Breed in the provided space.
  11. Choose your pet’s Color from the options available.
  12. Mark the Sex of your pet by selecting either Male or Female.
  13. Indicate whether your pet is Spayed/Neutered by selecting Yes or No.
  14. Fill in your pet’s Date of Birth (DOB).
  15. List the vaccinations your pet has received by checking the appropriate boxes under the Dogs section.
  16. For each vaccination checked, provide the Date it was administered and the Date Expires.
  17. Repeat the process for any vaccinations under the Cats section, if applicable.
  18. Finally, sign the form by providing your Veterinarian Signature and the Date of signing.

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Dos and Don'ts

When filling out the Proof of Vaccination Dog form, it's important to follow certain guidelines to ensure accuracy and completeness. Here are six things to do and not do:

  • Do provide accurate information about your pet's name and breed.
  • Do include your contact details, such as your phone number and address.
  • Do check the vaccination dates carefully, ensuring they are current.
  • Do have your veterinarian sign the form to validate the information.
  • Don't leave any sections blank; fill out every required field.
  • Don't forget to double-check for any spelling errors before submitting.

Common mistakes

  1. Not including the pet owner's contact information. Make sure to provide your phone number and address to ensure proper communication.

  2. Forgetting to specify the pet's species. Indicate whether your pet is a dog, cat, or other to avoid confusion.

  3. Leaving out the pet's breed. This detail is important for identification and record-keeping.

  4. Not marking the spayed/neutered status. Be sure to indicate whether your pet has been spayed or neutered.

  5. Failing to list all vaccinations received. Ensure that you check all relevant vaccinations to maintain accurate health records.

  6. Overlooking the dates of vaccinations. Each vaccination should have its date and expiration date clearly noted.

  7. Neglecting the veterinarian's signature. The form must be signed by a veterinarian to validate the information provided.

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