Wellness/Vaccination Check-In Sheet Online CompanyThis field is for validation purposes and should be left unchanged.Pet NameOWNER’S NAME First Last Date MM slash DD slash YYYY I am over 18 years of ageYesNoPet HousedIndoorOutdoorBothPhone # we can reach you at todayEmail WOULD YOU LIKE TO RECEIVE TEXT MESSAGES ABOUT YOUR PET’S PROGRESS WHILE THEY ARE IN THE CLINIC?YesNoIf your pet has been seen at another clinic, is it ok to request records from the previous clinic?YesNoClinic name and numberA routine wellness exam($40) is required once a year to ensure the health and well being of your pet. A new puppy/kitten wellness exam($47) is done at the first visit of any pet under the age of 1 year and includes a puppy/kitten care kit. (Up to $55 in value)Your pet is due for the following Vaccinations/blood testsCanine Select All Rabies- $29 Lyme- $44 Lepto only- $27 DHLP(Distemper)- $36 Bordetella(Kennel cough)- $31 Heartworm/Lyme 4dx Test(Blood draw)- $50.00 NONE DUE Feline Select All Rabies- $29 FVRCCP (Feline Distemper)- $28 Feleuk- $35 Feleuk/FIV Test(Blood Draw)- $52.00 NONE DUE Extras Select All Nail Trim ($27) Anal Gland Expression ($33) Fecal – basic ($46.34) Does your pet need any flea, tick, or heart worm preventative today?YesNoIf you have any health concerns, please specifySignature First Last Date MM slash DD slash YYYY
