INITIAL HEALTH INSPECTION

Veterinary Hospital Name & Address







Foster Home:______________________________________________

Address:__________________________________________________

City:______________________________________________________

State: ________________ Zip _______________________________

Phone:_____________________________

Date Examined: ______________________


Attending Veterinarian: (Please Print)_________________________________________

Breed: Airedale Terrier Sex:___Neut?:_____Age:_____Height:____Weight:_________

Breeder:________________________________________________________________

Tattoo # (if any):_______________________

or microchip ___________________________

The following vaccinations have been given:

DHL/P: Date:__________________________

Rabies: Date:______________________________

Was fecal exam for worms done?_______________Results:____________________

Was blood test for heartworm done?_____________Results:___________________

Is dog currently on Heartworm preventative?____________

Findings of initial visit:___________________________________________________

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

Vaccinations anticipated:____________________________________________________

Worming program needed:__________________________________________________

Heartworm Medication needed:______________________________________________

Was this animal X-rayed?_______________

If so, for what?___________________________________________________________

_______________________________________________________________________

Comments/Suggestions:____________________________________________________

_______________________________________________________________________

 

Attending Veterinarian's Signature:___________________________________________

Thank you for your help and time. Please return this form to Airedale Rescue c/o of the address above.

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Airedale Information

The ATCA Rescue & Adoption Committee fulfills the Airedale Terrier Club of America, Inc. ("ATCA") obligation to protect and advance the interests of the breed by providing services to lost, abandoned, abused or unwanted purebred Airedale Terriers.
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