Nebraska Airedale Terrier Association

My Pet's Health Checklist!!

Pet's Name: __________________ Birthdate: (Year______ Mo.______ Day _____)

Breed: _____________ Sex: (Circle one) INTACT M F or ALTERED M F (Date: _____)

Identification: DNA Profile: (Circle One) Y N AKC REG. # __________________

Tatoo #____________________ Microchip # ______________________

SCREENING TESTS:

TEST	DATE	RESULT

CURRENT VACCINATIONS: ( Indicate DATE! Please use pencil; update regularly!)

Rabies: ___________ DHLPP: ___________ OTHER: _______________

CURRENT MEDICATIONS: (Indicate date administered/drug/dosage/and condition for which drug was prescribed! Use pencil; update regularly!)

DATE:	MEDICATION/DOSAGE FOR:	CONDITION

CURRENT HEALTH PROBLEMS: ILLNESSES, INJURIES, AND SURGICAL INTERVENTIONS: (Please start on the bottom line to insure that your pet's most current health issues are readily accessible!)

DATE	SYMPTOMS	DIAGNOSIS	TREATMENT

THINGS THAT CONCERN ME ABOUT MY PET'S HEALTH: (e.g., ITCHY SKIN, POOR APPETITE, ETC. ! __________________________________________________________________________________ __________________________________________________________________________________