Canine Vaccination Consent Form

Name

First NameLast Name

Email

example@example.com

Phone Number

Please enter a valid phone number.

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Pet Name

Age

Breed

How often your pet is outdoors?

How often your pet visits boarding kennel?

How often your pet is groomed?

How often your pet visits boarding kennel?

AlwaysMostlyRarelyNever

List your pet's previous vaccinations

Any other specific details about your pet

I am the owner of a dog named above. I hereby authorize veterinarian service to administer the following vaccinations to my dog:

Rabies vaccination
Distemper vaccination
Parvovirus vaccination

I understand that these vaccinations are recommended to protect my dog from serious and potentially fatal illnesses, and that failure to vaccinate my dog may increase the risk of contracting these diseases.

I also understand that vaccination is not a guarantee that my dog will not contract these illnesses, but rather an important tool in preventing their spread and minimizing their impact.

I have been informed of the potential risks and side effects associated with these vaccinations, including but not limited to pain, swelling, fever, and allergic reactions. I understand that in rare cases, these side effects can be severe or even life-threatening.

I certify that my dog is in good health and has not exhibited any signs of illness or disease in the past 30 days. I agree to hold harmless the veterinarian, his/her associates, and employees from any and all claims arising from the administration of these vaccinations.

I have read and understand the above information, and hereby give my informed consent for the administration of these vaccinations to my dog.

Date

Signature of The Pet Owner

Canine Vaccination Consent Form

Owner Information

Pet Information

Vaccination Consent