Dog Vaccination Record

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Circle City Aminal Hospital

Dr. Bruce Choy


Corona CA 92879

Pet Health Record

Owner’s Information
First Name: Yassine Last Name: Smahi
M.I.:

Mailing Address: 27609 Stanford Dr.


City: Temecula State: California
ZIP: 928591

Home Phone: Work/ Cell Phone: (714) 313-1617

E-mail: yassisma13@gmail.com

Pet’s Information
Pet’s Name: Marie

Species: □ Canine □ Feline □ Other (specify)


Breed:
Boarder Collie / Dachshund
M □
M Neutered □
F □ Spayed□
Color:
Black & White
Birthdate or Age:
April 3, 2022
Weight:
5 lbs
Microchip Number:
PetLink - 985113007035192

Vaccination History
Dog Cat

Bordetell

Rabies
RCCP
Lepto

Other
DA2PP
Age Date

Rabies

FeLV
7 weeks 05/26/2022
11 weeks 06/23/2020

15 weeks 07/19/2022
7 months 11/22/2022

Other medications or procedures


Date Medication/ Procedure

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