Download Veterinary Certification Of Unfitness Of Dog Purchase for Free

Veterinary Certification Of Unfitness Of Dog Purchase - Free Download

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DateofExam:___________________________

OwnerofDogorCat:__________________________________________________________________________________

OwnerAddress:_________________________________________________________________________________________

OwnerTelephoneNumber:(______)___________________________________________________________________

AnimalSpecies:Canine___________Feline_______________

Breed:___________________________________________________________

Age:______________Sex:________________Color:________________

Diagnosis:________________________________________________________________________________________________

RecommendedTreatment:__________________________________________________________________________

______________________________________________________________________________________________________________

EstimateorActualCostofTreatment:___________________________

ThisistocertifypursuanttoArticle35‐DoftheGeneralBusinessLawoftheStateof

NewYork,thatIamaveterinariandulylicensedbytheStateof__________________,

thatIhaveexaminedtheaboveanimalassetforthhereinandthatIfindthatsaidani‐

malisunfitforpurchasedueto:(checkone)

_______illness

_______congenitalmalformationwhichadverselyaffectsthehealthoftheanimal

_______thepresenceofsymptomsofacontagiousorinfectiousdisease

SignatureofVeterinarian______________________________________________________Date:____________

NameofVeterinarian(printed):______________________________________________Lic#:____________

AddressofVeterinarian:_____________________________________________________________________________

PhoneNumberofVeterinarian:(______)__________________________

NewYorkStateDepartmentofAgricultureandMarkets

VeterinaryCertificationofUnfitnessofDogorCatForPurchase