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.