Disease Risk Assessment – Dog – Bellevue Animal Hospital

Owner’s Information

Name*

First Last

Phone*

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Pet's Information

In an effort to help keep your pet as healthy as possible, we want to provide you with some information that can help us decide the best vaccination protocol and schedule. The core vaccinations we provide on a routine basis are Distemper, Hepatitis (Adenovirus), Parainfluenza, Parvo (DHPP) and Rabies. DHPP vaccination is given in a series for puppies and then every 1-3 years as your dog ages. Rabies is given at 4 months of age, boostered in one year and then given every 2 years or every 3 years according to the ordinances in your city of residence. There are also non-core vaccines that may be given if your pet is considered at risk for these diseases. The three non-core vaccinations are listed below:

Please answer the questions in each section below for*

(write dog’s name)

Kennel Cough (Bordetella) - Most kennels require this vaccination within 6 months of boarding. The current vaccine does not prevent all strains of the disease. Should be done at least 7 days prior to boarding or event.

1. Goes to a groomer or a boarding facility.*

Yes

2. Goes to obedience classes or dog shows.*

Yes

3. Owner travels frequently and sometimes on short notice.*

Yes

Leptospirosis - This is a bacterial infection that spreads when your animal comes into contact with urine shed by wildlife, others dogs, or livestock. Leptospirosis generally causes flu-like symptoms in your pet and may progress to kidney and liver failure. Humans can also become infected by skin or moist tissue (eyes, mouth) coming in contact with the bacteria that is shed in the urine. In the past, there was an observed increased risk of vaccination reactions when this vaccination was given (particularly in puppies less than 12 weeks of age and toy breed dogs). The reactions included a swollen face and neck, hives, and/or vomiting. The vaccines which are currently available have decreased the risk of vaccination reactions. It is still safer to give this vaccination separate from other vaccines. Lepto requires an initial vaccination followed by a booster in 2-3 weeks (this timing is critical to develop a proper immune response), then an annual booster. The current vaccine does not prevent all strains of Leptospirosis. Lepto is required at some kennels.

1. Goes outside to urinate and defecate.*

Yes

2. Goes hunting, camping or to parks.*

Yes

3. Has access to a yard with wildlife traffic (mice, rats, skunks, possums, raccoons or squirrels)*

Yes

4. Has an opportunity to drink from, swim in, or stand in water outdoors (lake/stream/backyard pond)*

Yes

5. Lives in a rural area or a new housing development (developed within the past 10 years)*

Yes

6. Lives near or visits wooded areas*

Yes

Lyme Disease - This is a rickettsial disease transmitted by the Ixodes species of ticks. Symptoms include fever, muscle aches and pains, and/or lameness. Although Lyme disease is not extremely common in this area, there are a few cases reported every year. Vaccination requires a booster in 2-3 weeks followed by annual vaccination.

1. Has a high number of ticks when goes outside?*

Yes

2. Goes hunting, camping, to parks or wooded areas.*

Yes

3. Travels out of the state of Nebraska.*

Yes

4. Uses a tick control product (i.e. Frontline Gold.)*

Yes

Signature*

Date*

*Please inform us at any time if your pet’s lifestyle or environment changes, so that we may review their current vaccination schedule and advise you of our recommendations.

This field is for validation purposes and should be left unchanged.