• Privacy laws do not permit us to release medical information such as vaccine history without your permission. If another clinic, kennel or groomer requests this information may we release it? Please sign here to allow the release of this information:
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  • Please Provide Previous Records if Possible
  • NameDog/Cat/Bird/OtherBreedColorBirth Date (Approximate if necessary)Sex: Spayed Female/Female/Neutered Male/MaleMicrochip#Allergic to vaccines or medications?Currently taking medications/special diet?Please list any previous illnesses/surgeries: 
  • MM slash DD slash YYYY
  • This field is for validation purposes and should be left unchanged.