Veterinary Certification Of Unfitness Of Dog Purchase - Free Download
4.4, 3575 votes
Please vote for this template if it helps you.
Veterinary Certification Of Unfitness Of Dog Purchase
Veterinary Certification Of Unfitness Of Dog Purchase
DateofExam:___________________________
OwnerofDogorCat:__________________________________________________________________________________
OwnerAddress:_________________________________________________________________________________________
OwnerTelephoneNumber:(______)___________________________________________________________________
AnimalSpecies:Canine___________Feline_______________
Breed:___________________________________________________________
Age:______________Sex:________________Color:________________
Diagnosis:________________________________________________________________________________________________
RecommendedTreatment:__________________________________________________________________________
______________________________________________________________________________________________________________
EstimateorActualCostofTreatment:___________________________
ThisistocertifypursuanttoArticle35DoftheGeneralBusinessLawoftheStateof
NewYork,thatIamaveterinariandulylicensedbytheStateof__________________,
thatIhaveexaminedtheaboveanimalassetforthhereinandthatIfindthatsaidani
malisunfitforpurchasedueto:(checkone)
_______illness
_______congenitalmalformationwhichadverselyaffectsthehealthoftheanimal
_______thepresenceofsymptomsofacontagiousorinfectiousdisease
SignatureofVeterinarian______________________________________________________Date:____________
NameofVeterinarian(printed):______________________________________________Lic#:____________
AddressofVeterinarian:_____________________________________________________________________________
PhoneNumberofVeterinarian:(______)__________________________
NewYorkStateDepartmentofAgricultureandMarkets
VeterinaryCertificationofUnfitnessofDogorCatForPurchase
DateofExam:___________________________
OwnerofDogorCat:__________________________________________________________________________________
OwnerAddress:_________________________________________________________________________________________
OwnerTelephoneNumber:(______)___________________________________________________________________
Diagnosis:________________________________________________________________________________________________
RecommendedTreatment:__________________________________________________________________________
______________________________________________________________________________________________________________
EstimateorActualCostofTreatment:___________________________
ThisistocertifypursuanttoArticle35DoftheGeneralBusinessLawoftheStateof
NewYork,thatIamaveterinariandulylicensedbytheStateof__________________,
thatIhaveexaminedtheaboveanimalassetforthhereinandthatIfindthatsaidani
malisunfitforpurchasedueto:(checkone)
_______illness
_______congenitalmalformationwhichadverselyaffectsthehealthoftheanimal
_______thepresenceofsymptomsofacontagiousorinfectiousdisease
SignatureofVeterinarian______________________________________________________Date:____________
NameofVeterinarian(printed):______________________________________________Lic#:____________
AddressofVeterinarian:_____________________________________________________________________________
PhoneNumberofVeterinarian:(______)__________________________
Veterinary Certification Of Unfitness Of Dog Purchase Previous Page
source: agriculture.ny.gov
Veterinary Certification Of Unfitness Of Dog Purchase
Previous

1/1

Next