CONTACT information
DOG HEALTH
Name:
OWNER’S INFORMATION
____________________________________________
Address: ___________________________________________
City _______________________STATE___________________
Home Phone: _______________________________________
Cell Phone: (_________)______________________________
Work Phone: (_________)_____________________________
VETERINARIAN’S INFORMATION
Name: ____________________________________________
Address: __________________________________________
City _______________________STATE___________________
Phone: (_________)_________________________________
EMERGENCY CONTACT INFORMATION
Name: ____________________________________________
Relationship: _______________________________________
Phone: (_________)_________________________________
Emergency #: (_________)____________________________
GROOMER’S INFORMATION
Name: ____________________________________________
Phone: (_________)_________________________________
Collar Size: _________________________________________
Last Shampoo: _____________________________________
Last Bath: _________________________________________
Comments: ________________________________________
__________________________________________________
__________________________________________________
PET’S information
Name: _______________________________________________
Gender: ______________________________________________
RECORDS
o Spayed o Neutered keeping track of your pet’s health
Breed: ________________________________________________
Date of Birth: __________________________________________
Height: ___________________ Weight: _____________________
Registration #: __________________________________________
Registered Name: ______________________________________
Sire’s Reg. #: ___________________________________________
Sire’s Name: ___________________________________________ “Your Pet’s Photo”
Sire’s Breed: ___________________________________________
Dame’s Reg. #: _________________________________________
Dame’s Name: _________________________________________
Dame’s Breed: _________________________________________
PET’S IDENTIFICATION
Microchip ID Number: ___________________________________
License Number: _______________________________________
Collar Color: ___________________________________________
Identifying Markings: ___________________________________
_____________________________________________________
_____________________________________________________
SPECIAL MEDICAL INFORMATION 800-344-6337 | www.LambertVetSupply.com
Diet: _________________________________________________
Name: __________________________________
_____________________________________________________
_____________________________________________________ Date of Birth: _____________________________
Allergies: _____________________________________________ Breed: ___________________________________
_____________________________________________________
_____________________________________________________
Sex: _____________________________________
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