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*Client
Client ID #
*Pet's Name
Pet's ID #
Breed
Age
Date of Last Rabies Vaccination
Date of Last Distemper Vaccination

Please give the approximate dates if your pet was vaccinated for any of the following:
Leptospirosis
Lyme Disease
Bordetella
Date of Last Heartworm Test
Do you use Heartworm Preventative? (Y/N)
Do you use Flea/Tick Preventative? (Y/N)
Date of Last Fecal Examination
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