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Excelsior’s Havanese
Winston, Oregon
VETERINARIAN INITIAL EXAMINATION FORM
As a condition of sale and warranty coverage.
This Veterinarian Examination Form is to be filled out by your Vet and mailed or e-mailed back
to Excelsior’s Havanese Puppies (paul.sodhoppers@q.com)
within 14 days of the arrival of your clients puppy.
Failure to comply with these conditions will Void the Warranty.
COAT AND SKIN
Bright/Shiny Good Condition _____ Abnormalities Noted __________________________________
_______________________________________________________________________________
PARASITES PRESENT (All puppies leave my home with no Fleas Ticks or Lice) if they are
present provide Frontline, Advantage, or other treatment during this visit and instruct client on care
Present at exam Fleas ____ Ticks ____ Lice ____
Other Lesions Noted _____________________________________________________________
EYES Clear ____ Odor Free ____ Discharge ____ Red ____
Abnormalities Noted ______________________________________________________________
LUNGS Clear ____ Coughing ____ Congested ____
Abnormalities Noted ______________________________________________________________
HEART Normal Rhythm ____ Murmur ____ Grade ____
Is Testing Required, if so what _______________________________________________________
UROGENITAL Normal Non Painful ____ Testicles Present (Males Only)____
If not check for scar to see if Neutered or noted on health certificate. Notes____________________________________________________________________________
LEGS, JOINTS, PAWS Normal non Painful ____ Limping ___ If limping when was it reported
to you ___________________________________________________________________________
Results of x-ray if required?
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
PUPPIES WITH INCORRECT BITES ARE SOLD TO YOUR CLIENTS AS PETS ONLY.
NORMAL ____ ABNORMAL ____ Please Explain if abnormal
and not listed on vet health shipping certificate.__________________________________________________________________________________
__________________________________________________________________________________
NEUROLOGICAL BEHAVIOR Normal Puppy behavior ____ Lethargic ____
Abnormalities Noted __________________________________________________________________
___________________________________________________________________________________
FECAL EXAMINATION Negative ____ Positive ____ For __________________________________
Treatment Provided ___________________________________________________________________
___________________________________________________________________________________
OVER ALL CONDITION EXCELLENT ____ GOOD ____ FAIR ____ PLEASE EXPLAIN ___________________________________________________________________________________
___________________________________________________________________________________
Do you find this puppy fit for purchase by your client? YES ____ NO _____
If NO - Please DO NOT TREAT.
Have your client Contact us immediately to make arrangement to have the
puppy returned for a refund or replacement as per the Contract Guarantee.
Please explain in detail _________________________________________________________________ ___________________________________________________________________________________
___________________________________________________________________________________
Please Note The Buyer has been provided a Health Record of all past vaccines and worming.
The puppy will also have a Veterinarian Examination Health Certificate, if the puppy was
shipped. Both documents should be provided to you or staff at this first visit.
Puppy is current on Vaccines at time of new owner possession, but may be due for boosters. Please look over the Health Records and administer any needed vaccinations during this visit or within one week.
Although your area may not be susceptible to heart worm, I still recommend HEARTGARD for all our Havanese because this is an area of concern for this particular breed. It is a small price to pay for ongoing health and peace of mind.
CLIENTS NAME ____________________________________________________________________
CITY ___________________ STATE ___________
NAME OF DOG __________________ BREED ______________________ DOB _________________
SEX _________ COLOR ______________________________________________________________
Thank you very much for taking the time to honor this request.
VET SIGNATURE____________________________________________________________
LIC. #______________________
Please Mail Signed Form to: Paul Wilson - 141 Winston Section Road - Winston, OR 97496
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