Note: This is a sample medical record that you can adapt to fit your particular situation.
Medical Record
Name of pet_________________________Breed_________________________
Color______________________ Markings______________________________
Date of birth _____________________ Approximate ___ Exact ___
Sex: ___ Male ___ Female Neutered or spayed? ___ Yes ___ No
If yes, date of surgery ___________________________
General history ________________________________________________________________
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Veterinarian’s name_______________________Phone____________________
Date of FeLV test (feline only) ___________________ Results: ___ Pos ___ Neg
Date of FIV test (feline only) ___________________ Results: ___ Pos ___ Neg
Date of heartworm test (canine only) _____________ Results: ___ Pos ___ Neg
Date of last rabies vaccination ______________ Tag #_____________________
Next rabies vaccination due ______________________
Other vaccination__________________________Date___________________
Other vaccination__________________________Date___________________
Other vaccination__________________________Date___________________
Illnesses, treatments ________________________________________________________________
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Other comments ________________________________________________________________
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