Name:
CONTACT information
OWNERS INFORMATION
PETS information
Name:
Gender:
DOG HEALTH
RECORDS
Address:
City STATE
Home Phone:
Cell Phone: ( )
Work Phone: ( )
VETERINARIANS INFORMATION
Name:
Address:
City STATE
Phone: ( )
EMERGENCY CONTACT INFORMATION
Name:
Relationship:
Phone: ( )
Emergency #: ( )
o Spayed o Neutered
Breed:
Date of Birth:
Height: Weight:
Registration#:
Registered Name:
Sires Reg. #:
Sires Name:
Sires Breed:
Dames Reg. #:
Dames Name:
Dames Breed:
PETS IDENTIFICATION
Microchip ID Number:
License Number:
Collar Color:
Identifying Markings:
Keeping track of your pets health
Congratulations on your new puppy from.
GROOMERS INFORMATION
SPECIAL MEDICAL INFORMATION
Diet:
Name:
Name:
Phone: ( )
Collar Size:
Last Shampoo:
Last Bath:
Comments:
__________________________________________________
Allergies:
Medical Conditions:
Date of Birth:
Breed:
Sex:
Markings:
Veterinarian:
__________________________________________________
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VACCINATION history
FECAL/DEWORMING
Date Results
_______ _____________________________________
MEDICAL notes
Date Results
_______ _____________________________________
Age Date
wks o
wks
o
wks o
wks o
wks o
1 year
o
2 years
o
3 years
o
4 years
o
5 years
o
6 years
o
7 years o
o o o
o o o
o o o
o o o
o o o
o o o
o o o
o o o
o o o
o o o
o o o
o o o
o o o o
o o o o
o o o o
o o o o
o o o o
o o o o
o o o o
o o o o
o o o o
o o o o
o o o o
o o o o
_______ ___________________________________
_______ ___________________________________
_______ ___________________________________
_______ ___________________________________
_______ ___________________________________
_______ ___________________________________
_______ __________________________________
_______ __________________________________
_______ __________________________________
_______ _____________________________________
HEARTWORM history
_______ ___________________________________
_______ ___________________________________
_______ ___________________________________
_______ ___________________________________
_______ ___________________________________
_______ ___________________________________
_______ __________________________________
_______ __________________________________
_______ __________________________________
_______ __________________________________
_______ __________________________________
_______ _____________________________________
8 years
o
9 years
o
10 years
o
11 years
o
12 years
o
13 years
o
14 years
o
15 years
o
16 years
o
o o o
o o o
o o o
o o o
o o o
o o o
o o o
o o o
o o o
o o o o
o o o o
o o o o
o o o o
o o o o
o o o o
o o o o
o o o o
o o o o
2 - 5 Weeks
First deworming
at 2 weeks
Second deworming
6 - 12 Weeks
at 6 weeks
at 8 weeks
Fifth deworming
at 10 weeks
Sixth deworming
at 12 weeks
Date
Date
Vaccination
Vaccination
_______ ___________________________________
_______ ___________________________________
_______ ___________________________________
_______ ___________________________________
_______ ___________________________________
_______ ___________________________________
_______ ___________________________________
_______ __________________________________
_______ __________________________________
