A Pawsitive Experience requires a Health Exam, vaccines and fecal testing indicated, before assessment. Exam must be within 30 days of first appearance - no less than 10 days. Have your Vet fill in the form, INITIAL EACH LINE, provide the dates of vaccination or Titers (provide Results) and fecal tests results. Fax, copy & return ORIGINAL to A Pawsitive Experience.  Parasite and bacteria clearance annual requirement for attendance.   CERTIFICATE MUST BE EXECUTED IN FULL BEFORE DOG IS ALLOWED ON PROPERTY

( Insert Vet Office, Name, Address, Phone in Adjoining Space )

Owner:

Dog:

Address:

Breed/Sex:

City:

Birth Date & Age Now:

Phone:

Color:

DATE GIVEN

VET INITIALS

NOTES

DAP

LEPTO (only if high risk & vet recommended)

RABIES (Per State Rqmts.)

CANINE COUGH (Annual)

OTHER (Flea Checked & Nails Clipped)

*Vet Note: Vaccines at your discretion. Indicate Titer results, vaccines given/withheld and why. Vet’s initial required in each space.

DATE

VET INITIALS

RESULTS, NOTES & RX

Parasites

Coccidia

Giardia (SNAP or ELIZA Test Only Accepted - smear not acceptable)

Heartworm (8 months & older: Annual Test only req’d - Treatmt @ Vet & Client Option)

I certify that (1) I have, within the last 30 days,examined and tested this patient as indicated above and: found them to be in good health, free of signs of infectious diseases, parasites including but not limited to fleas, lice, diarrhea, coughing, nasal drip or conjunctivitis on this date AND/OR (2) This is a special needs dog requiring the following:  _________________________________________________________________________________________________________________________________________________.

Exectued by  _________________________________________, DVM on this  _____ day of   ________________,  2009