CONTACT information PET’S information
DOG HEALTH
Name:
OWNER’S INFORMATION
____________________________________________
Name: _______________________________________________
Gender: ______________________________________________
RECORDS
Address: ___________________________________________ o Spayed o Neutered keeping track of your pet’s health
City _______________________STATE___________________ Breed: ________________________________________________
Home Phone: _______________________________________ Date of Birth: __________________________________________
Cell Phone: (_________)______________________________ Height: ___________________ Weight: _____________________
Work Phone: (_________)_____________________________ Registration #: __________________________________________
Registered Name: ______________________________________
Sire’s Reg. #: ___________________________________________
VETERINARIAN’S INFORMATION
Sire’s Name: ___________________________________________ “Your Pet’s Photo”
Name: ____________________________________________ Sire’s Breed: ___________________________________________
Address: __________________________________________ Dame’s Reg. #: _________________________________________
City _______________________STATE___________________ Dame’s Name: _________________________________________
Dame’s Breed: _________________________________________
Phone: (_________)_________________________________
PET’S IDENTIFICATION
EMERGENCY CONTACT INFORMATION Microchip ID Number: ___________________________________
License Number: _______________________________________
Name: ____________________________________________
Collar Color: ___________________________________________
Relationship: _______________________________________
Identifying Markings: ___________________________________
Phone: (_________)_________________________________
_____________________________________________________
Emergency #: (_________)____________________________
_____________________________________________________
SPECIAL MEDICAL INFORMATION 800-344-6337 | www.LambertVetSupply.com
GROOMER’S INFORMATION
Diet: _________________________________________________
Name: ____________________________________________
Name: __________________________________
_____________________________________________________
Phone: (_________)_________________________________ _____________________________________________________ Date of Birth: _____________________________
Collar Size: _________________________________________ Allergies: _____________________________________________ Breed: ___________________________________
Last Shampoo: _____________________________________ _____________________________________________________
Last Bath: _________________________________________ _____________________________________________________
Sex: _____________________________________
Comments: ________________________________________ Medical Conditions: ____________________________________ Markings: ________________________________
__________________________________________________ _____________________________________________________
Veterinarian: _____________________________
__________________________________________________ _____________________________________________________
VACCINATION history FECAL/DEWORMING MEDICAL notes
Distemper-Hepatitis
Canine Parvovirus
Date Results Date Results
Parainfluenza
Leptospirosis
______________________________________________ ______________________________________________
Bordetella
Rabies
Dental
____________________________________________ ____________________________________________
Lyme
Age Date
wks o o o o o o o o ____________________________________________ ____________________________________________
wks o o o o o o o o ____________________________________________ ____________________________________________
wks o o o o o o o o ____________________________________________ ____________________________________________
wks o o o o o o o o ____________________________________________ ____________________________________________
wks o o o o o o o o ____________________________________________ ____________________________________________
1 year o o o o o o o o ____________________________________________ ____________________________________________
2 years o o o o o o o o ___________________________________________ ___________________________________________
3 years o o o o o o o o ___________________________________________ ___________________________________________
4 years o o o o o o o o ___________________________________________ ___________________________________________
5 years o o o o o o o o ______________________________________________ ___________________________________________
6 years o o o o o o o o ___________________________________________
7 years o o o o o o o o
HEARTWORM history ______________________________________________
8 years o o o o o o o o 2 - 5 Weeks Date Vaccination
____________________________________________
9 years o o o o o o o o First deworming
at 2 weeks
____________________________________________
10 years o o o o o o o o Second deworming ____________________________________________
at 4 weeks
11 years o o o o o o o o ____________________________________________
6 - 12 Weeks Date Vaccination
12 years o o o o o o o o ____________________________________________
Third deworming
13 years o o o o o o o o at 6 weeks ____________________________________________
Fourth deworming
14 years o o o o o o o o at 8 weeks
____________________________________________
Fifth deworming
15 years o o o o o o o o at 10 weeks
___________________________________________
16 years o o o o o o o o Sixth deworming ___________________________________________
at 12 weeks
