Vaccine Clinic Pre-registration

First name*

Last name*

Co-owner

Email*

Phone*

Mailing Address*

Kennel Name (if applicable)

Upload Previous Vaccine Records

Maximum of 5 files per form submission. If you have more than 5 pets please submit multiple forms.

Animal #1 Name*

Single choice*

Canine

Feline

Other

Breed*

Sex*

Female

Spayed Female

Male

Neutered Male

Age*

Color/Markings*

Microchip Number

Vaccines Needed

Rabies

5 way

Kennel Cough

Lepto

Additional Animals?*

Contact

Phone

(907) 931-7345

Hours

Monday - Friday

8am - 5pm

Areas of Service

Fairbanks North Star Borough

and surrounding communities

Email

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