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