Health Record Overview

Please complete, and make sure to click "Submit" at the end. This form is required before transport. Thank you!

Spay or Neuter? *
Please enter "None" for no allergies or other notable issues
Rescue Date *
Rescue Date
Vaccinations / Medications / Tests
Please Indicate Heartworm Status Upon Intake *
Heartworm Test #1
Heartworm Test # 1 - Date *
Heartworm Test # 1 - Date
Heartworm Test #1 - Result *
Heartworm Test #2
Heartworm Test #2 - Date *
Heartworm Test #2 - Date
Heartworm Test #2 - Result *
If the Dog Tested Positive for Heartworm, at Any Time, Please Let Us Know the Date the Treatment Started and the Date Treatment Ended
If Positive, Date Treatment Started
If Positive, Date Treatment Started
If Positive, Date Treatment Ended
If Positive, Date Treatment Ended
Heartworm Preventative / Dosage
Flea and Tick Preventative/Dosage
Rabies Vaccination
For puppies, please indicate date(s) of each round
DHLPP
Bordetella
Heartworm Test
Fecal Test
Dewormer
Please indicate date of 1st Round and also when the 2nd Round is due
Please indicate date of 2nd Round and also when the 3rd Round is due
Adult Dewormer
PLEASE DON'T FORGET TO CLICK "SUBMIT" TO SEND YOUR COMPLETED FORM. THANK YOU!!