Final Step – Print Your Form

Your appointment request has been received. If you need to change your appointment please contact us via email lowcostvaccination@att.net or via telephone at 1-800-978-3910.

Click here to print the required paperwork you will need to bring with you to your appointment.

(800) 978-3910

How did you hear about our clinic today?

1. Petco

2. Flyer-Handout

3. Repeat Service

4. Annual Shots

5. Yearly Visit

6. Other

OWNER'S LAST NAME

FIRST

Middle Initial

MAILING ADDRESS

CITY

STATE

ZIP

PHONE NUMBER

ID#

12/21/2024

ANIMAL'S NAME

TODAY'S DATE

Species
Dog
Cat
Ferret

Sex
Male
Female
Spay/Nt

Age
Under 3mo
3mo - 12mo
12mo/older

Size
Under 25 libs.
26 - 50 lbs
Over 50 lbs

Predominant Breed
____________
____________

Colors
_________
_________

RABIES CERTIFICATE

TAG NUMBER

PRODUCER

PROD. NAME

1 yr. Lic/Vacc.

3 yr. Lic/Vacc.

___________	_______
Vacc. Serial (lot) No.	Expiration Date

DATE VACCINATED:

__________________20______

Veterinarian's #:	______________
	License No.

P. O. Box 1165 - Vidalia, LA 71373

drajhall@lowcostvaccination.com - lowcostvaccination.com

Doctor	______________________________
	Signature

AGE________	N	ABN
Temp_______
Teeth/Mouth
Ears
Eyes
Skin
Heart/Lung

1.	PUPPY PACK
	DA2PPv, Bordetella and Deworm
2.	DOG PACK
	DA2PPv, Bordetella and Rabies
3.	SUPER DOG PACK
	DA2PPv, Bordetella Rabies and Heart Worm Test
4.	KITTY PACK
	RCP+Felv and Deworm
5.	CAT PACK
	RCP+Felv and Rabies
6.	SUPER CAT PACK
	FvRCPC+Felv, Bordetella and Rabies
7	RABIES
8.	LYME
9.	FIP VACCINE
10.	FIV VACCINE
11.	FERRET DISTEMPER
12.	FERRET RABIES
13.	HEARTWORM TEST
14.	FELINE FeL V/FIV TEST
15.	FELINE LUKEMIA TEST
16.	FECAL (STOOL) TEST
17.	HEARTWORM PREVENTION
18.	FELINE HEARTWORM PREVENTION
19.	FRONTLINE
20.	MICROCHIP
21.	OTHER
			TAX
CC	CASH	CHECK#	TOTAL