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The Proof of Vaccination Dog form is an essential document for pet owners, providing vital information regarding their dog's vaccination history. This form typically includes details such as the pet owner's name, contact information, and the pet's name, breed, and date of birth. It specifies the vaccinations administered, including DHPP, Bordetella, Rabies, Leptospirosis, and Lyme, along with the dates of administration and expiration for each vaccine. In addition, the form indicates whether the dog is male or female and if it has been spayed or neutered. A veterinarian's signature is required to certify that the dog is current on the vaccinations listed. This form serves not only as proof of vaccination but also as a crucial record for pet owners to ensure their dogs are protected against various diseases. It is important for pet owners to keep this document updated and readily accessible, especially when traveling or visiting facilities that require proof of vaccinations.

Document Data

Fact Name Description
Purpose of the Form This form serves as proof that a dog has received necessary vaccinations.
Required Information Pet owners must provide their contact details, pet's name, species, breed, color, and sex.
Vaccination Details The form includes sections for various vaccinations, such as DHPP, Rabies, and Bordetella.
Expiration Dates Each vaccination listed must have a corresponding expiration date to ensure validity.
Veterinarian Certification A veterinarian must sign the form to certify that the pet is current on vaccinations.
State-Specific Forms Some states may require specific forms or additional information based on local laws.
Legal Requirement Many states mandate proof of vaccination for dogs to prevent the spread of diseases.
Record Keeping Pet owners should keep a copy of this form for their records and future reference.
Use of the Form This form is intended for individual clinic use and should not be distributed without permission.
Copyright Information The form is copyrighted and should not be altered or reproduced without consent.

How to Write Proof Of Vaccination Dog

Once you have the Proof Of Vaccination Dog form, you can begin filling it out. This form is essential for documenting your pet's vaccinations. Follow the steps below to ensure that all necessary information is accurately provided.

  1. At the top of the form, enter the Name of Clinic and include the Logo if available.
  2. If desired, fill in the Address of the clinic.
  3. Provide the clinic's Phone number.
  4. In the Pet Owner’s Name section, write your full name.
  5. Enter your Phone No. for contact purposes.
  6. Fill in your Pet Owner’s Address for verification.
  7. Next, write your pet’s Name.
  8. Indicate the Species of your pet by selecting from Dog, Cat, or Other.
  9. In the Breed section, specify your pet's breed.
  10. Fill in your pet’s Color.
  11. Choose your pet’s Sex by marking either Male or Female.
  12. Indicate if your pet is Spayed/Neutered by selecting Yes or No.
  13. Provide your pet’s DOB (Date of Birth).
  14. Under the section for vaccinations, check the vaccines your dog has received: DHPP, Bordatella, Rabies, Leptosporosis, or Lyme.
  15. For each vaccine checked, fill in the Date administered and the Date Expires.
  16. At the bottom of the form, certify that your pet is current on the vaccinations by signing in the Veterinarian Signature area.
  17. Finally, write the Date of the signature.

After completing the form, review it for accuracy. Ensure all sections are filled out correctly. Once verified, submit it to the appropriate clinic or organization as instructed.

Proof Of Vaccination Dog Example

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.

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