Parent-Please print, complete your portion of this form and submit it to your Veterinarian.

Dear Doctor,

Please complete this form and fax it to:  Dogma Dog Daycare & Spa at 325-3562 to enable my dog to enroll.  This form is to verify that my dog is current on the listed vaccinations and in good health.  Thank you.

Dog's name: ____________.  I, the parent, hereby warrant that my dog is on FRONTLINE, and I will provide my receipt or show my existing supply at the interview.

Parent Printed Name: _______________ Date: _____             

Veterinarian:

1.  Date of last vet visit:___________

2.  Spayed/Neutered: Yes/No (circle one)

3.  Vaccinations:

     Rabies: Last Given ______, Next Due: _____

     DHLPP: If Adult--Last Given _____, Next Due _____

                              If Puppy--Round 1 _____, Round 2 _____, Round 3 _____,

                              Next Due _____

     Bordatella: *We require every 6 months* Last Given _____, Next Due _____

4.  Fecal Exam: *We require annually* Last Given _____, Results: _____

5.  Additional Comments: _______________________________________________

     Veterinarian's Signature: _______________ Date: _____

     Clinic Name: ______________________________________

PLEASE FAX TO DOGMA DOG DAYCARE & SPA AT 325-3562

Dogma, LLC, A Daycare & Spa for Dogs, 2708 N. Country Club Rd., Tucson, AZ, 85716, ph: 325-3665   www.DogmaDogDaycare.com

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