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

National Airedale Rescue, Inc., is a non-profit 501(c)(3) corporation and is the Official Treasury of the Airedale Terrier Club of America (ATCA) Rescue & Adoption Committee. Funds donated to National Airedale Rescue, Inc. are distributed on an as-needed basis to Airedale Rescue volunteers and groups who have agreed to abide by the Airedale Terrier Club of America Rescue & Adoption Committee policies and guidelines.

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