Client / Non Client VIP Vaccination Clinic
PLEASE READ: If you wish to have your pet(s) vaccinated, microchipped or tested for heartworm and or FELV/FIV fill out this form. Only serious inquiries please, do not fill this form out if you are not seriously considering vaccinations.

VIP Petcare will provide these RECOMMENDED vaccinations, microchips and tests to your family pet FREE of charge. PLEASE ADVISE US IF YOU DO NOT WANT ONE OR MORE OF THESE SERVICES.
Canine Distemper (5 in 1) vaccine
Canine Bordetella vaccine
Canine Heartworm Test
Feline FVRCP vaccine
Feline Leukemia vaccine
Feline FeLv/FIV Test
Microchip (Cat & Dog)

If your pet is 12 weeks or older and has never been vaccinated or it's been more than a year since their last vaccination, he or she will need a series of TWO vaccinations. Otherwise, puppy and or kittens 11 weeks and under will require a series of THREE vaccinations before 16 weeks of age. Your pet will automatically be scheduled for the next series at the time of your current visit. A volunteer will contact you to set up a Date of Service with you.

After this form is submitted, a volunteer from our team will contact you. He or she will share the details of the program and set up a Date and time for you to bring your pet(s) in.
Applicants Name *
Applicants Address *
Are you a CPOC client? *
Applicants eMail Address *
Applicants Telephone # *
Can we text the applicant at this number? *
Has your pet ever been vaccinated? *
Has it been over a year since their last vaccination? *
Name of Pet # 1? *
Is Pet #1 a Cat or Dog? *
Breed of Pet #1? i.e Lab, Lab mix or Calico, Tabby *
How old is Pet # 1? *
Color of Pet #1? *
Weight of Pet #1? *
Name of Pet #2?
Is Pet #2 a Cat or Dog?
Clear selection
Breed of Pet #2? i.e Lab, Lab mix or Calico, Tabby
How old is Pet # 2?
Color of Pet # 2?
Weight of Pet # 2?
Name of Pet #3?
Is Pet #3 a Cat or Dog?
Clear selection
Breed of Pet #3? i.e Lab, Lab mix or Calico, Tabby
How old is Pet # 3?
Color of Pet # 3?
Wright of Pet # 3?
Name of Pet #4?
Is Pet #4 a Cat or Dog?
Clear selection
Breed of Pet #4? i.e Lab, Lab mix or Calico, Tabby
How old is Pet # 4?
Color of Pet #4?
Weight of Pet #4?
Has your pet had an allergic reaction to vaccinations in the past? *
Does your pet have any health issues, including dietary? If so, explain, If Not, use N/A. *
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