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Health Report

Minimum Required Vaccination Schedule

6 - 8 weeks
  • Distemper / Parvo / Adenovirus / Parainfluenza Combo
  • Bordetella (at veterinarian's discretion)
  • Deworming (to be started at 2 weeks old)
9 - 11 weeks
(3 weeks later)
  • Distemper / Parvo / Adenovirus / Parainfluenza Combo
  • Corona (at veterinarian's discretion)
  • Deworming
12 - 14 weeks
(3 weeks later)
  • Distemper / Parvo / Adenovirus / Parainfluenza Combo
  • Corona (at veterinarian's discretion)
  • Rabies (required by airlines to be done at 12 weeks old)
  • Bordetella (at your veterinarian's discretion)
    (nasal version not to be given within 5 days of departure)
  • Deworming
Annually
  • Distemper / Parvo / Adenovirus / Parainfluenza Combo
  • Rabies
  • Bordetella

Vaccination / Deworming History

(If any of these do not apply to your veterinary protocol, please indicate "too young" or "N/A".)
No vaccine to be given within 3 days of a puppy's flight.

Date or
Week # 		Route
(IM/SQ) 		Initials of
Administrator 		Manufacturer Lot Number Vaccinations / Dewormings
          Distemper / Parvo / Adenovirus / Parainfluenza Combo
          Bordetella (at veterinarian's discretion)
          Deworming
          Distemper / Parvo / Adenovirus / Parainfluenza Combo
          Corona (at veterinarian's discretion)
          Deworming
          Distemper / Parvo / Adenovirus / Parainfluenza Combo
          Corona (at veterinarian's discretion)
          Rabies (must be administered by veterinarian)
          Bordetella (at veterinarian's discretion)
          Deworming

Breeder Name

Puppy ID Number

Breeder's Veterinary Report Form

Breed  
Date of Birth  
Cardiovascular Yes No Grade
Heart Murmur      
General Condition  
Skin and Coat Yes No
Fleas/Ticks    
Alopecia    
Signs of Infection    
General Condition  
Eyes Yes No
Abnormal Discharge    
Vision Problems    
Eyelash Disorders    
Cherry Eye    
Mouth, Teeth, Gums Yes No
Malocclusion     Size
Overbite/Underbite      
General Condition  
Musculoskeletal Yes No
Umbilical Hernia    
Inguinal Hernia    
Hip Pain     Grade
Patellar Luxation      
  Yes No Size (cm)
Open Fontanelle      
General Condition  
Color  
Weight (lbs)  
Temperature (F)  
Pulse (BPM)  
Respiratory Rate (BPM)  
Respiratory Yes No
Coughing/Congestion    
Stenotic Nares    
General Condition  
Ears Yes No
Abnormal Debris/Discharge    
Ear Mites    
Signs of Infection    
Urogenital Yes No
Redundant Vulva    
Undescended Testicles/Cryptorchid    
General Condition  
Gastrointestinal Yes No
History of Vomiting    
History of Diarrhea    
General Condition  
Required Fecal Exam by Veterinarian
Date Given  
Results  
Medications Prescribed  
History of Past Surgeries?  
Any Additional Notes
 
 
Breeder Signature
Date

 
Veterinarian Signature
Date

 
Breeder Printed Name Vet Printed Name
   
   
Puppy ID Number Vet Phone Number
   
   
   

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