Vaccination Consent Form

This form will be used for any vaccinations for a pet

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Owner's Name

Immunizing your pet is an important procedure that in most cases will provide protection against an illness that may be life threatening. A series of shots will be given at the beginning of a pet's life or for pets that are unvaccinated and other shots will be given yearly or every three years based on the risks of contracting the disease.

Most pets show no ill effect from vaccinations. Vaccine reactions may be minor and short-lived or require immediate care from a veterinarian. Clinical signs include: fever, lethargy, facial swelling and/or hives, vomiting, diarrhea, pain, swelling, redness, scabbing, or hair loss around the injection site, difficulty breathing, and seizures. Certain immune mediated diseases such as hemolytic anemia (anemia caused by red blood cell destruction), thrombocytopenia (low blood platelet numbers), and polyarthritis (joint inflammation and pain) in dogs may be triggered by the body’s immune response to a vaccine. In cats, a serious additional concern has been a “lump” forming at the site of the vaccination caused by a substance in the vaccine called an adjuvant. In some cats, if these lumps persist, a tumor may form called a fibrosarcoma which may have grave consequences if ignored. If your cat develops a lump under the skin following a vaccination that persists for longer than four weeks, you should have it examined as soon as possible. Your decision to vaccinate your pet should not be taken lightly. A decision should only come after your pet’s age and the risk of exposure to disease are considered by you and your veterinarian. Vaccinations given at the appropriate age and at the appropriate intervals will greatly benefit your pet and protect it against some life threatening diseases.

Core Vaccinations for dogsCore Vaccination for catsCore Vaccinations for horses
  • Canine Distemper
  • Canine Adenovirus type 2
  • Parvovirus
  • Rabies
  • Feline Herpesvirus
  • Panleukopenia
  • Calicivirus
  • Rabies
  • Tetanus
  • West Nile Virus
  • Eastern Encephalitis Virus
  • Western Encephalitis Virus
  • Rabies
Non-Core Vaccinations for dogsNon-Core Vaccinations for dogsNon-Core Vaccinations for horses
  • Parainfluenza (within adult and puppy vaccine)
  • Leptospira (within adult vaccine)
  • Coronavirus (within puppy vaccine)
  • Bordetella
  • Lyme Disease
  • Chlamydia psittaci (within combination vaccine)
  • Feline Leukemia Virus
  • Equine Herpes Virus types 1 and 4
  • Influenza (3 strains)

I certify that I have read the above information and I am now aware of the risks associated with failure to vaccinate my pet as well as the potential side effects associated with receiving the vaccination. By signing this consent form I authorize the administration of the vaccinations checked on the form above to my pet. Because vaccination reactions are not predictable, I agree that the veterinarians shall not be held liable for any reactions related to the administration of vaccinations administered to my pet. I further agree to hold my veterinarian harmless when in the event the effort to reduce the frequency and minimize known complications of vaccination inadvertently increases my pet’s risk when exposed to a disease and I shall be responsible for fees related to treating any of the diseases for which a vaccine was not administered.

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