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4-H Vaccine Clinic Form 2020
Horse Owner's Name
*
Address
*
Phone
*
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Email
*
4-H Club
*
Horse's Name
*
Breed
*
Age
*
Sex
*
Mare
Gelding
Color
*
Does your horse have a
history of reactions to
vaccines or medications?
*
Yes
No
If yes, please describe.
In addition to the required
vaccines, would you like to
have your horse vaccinated
against Strangles at an
additional cost of $41.00
*
Yes
No
Terms for the 4-H vaccine clinic are as follows: Your horse will receive a brief physical examination including assessing the body condition as well as listening to the heart and lungs and taking the temperature (if the horse is cooperative). This information will be included on the invoice printed at the time of the exam.
Your horse will then be vaccinated against the following diseases: West Nile Virus, Eastern Equine Encephalitis, Western Equine Encephalitis, Tetanus, Rhinopneumonitis (Equine Herpes Virus), Influenza, and Rabies. If requested in advance, a Strangles (Streptococcus equi) vaccination can be provided at an additional cost of $41.00
The price for the required vaccines will be $121.50($162.50 if requesting a strangles vaccine) per horse, reflecting a 10% savings off of standard fees as well as waiving the call fee.
A check, made out to Flying Horse Veterinary Practice should be presented at the time of service.
Unfortunately, due to time constraints, additional examinations/services cannot be provided during the vaccine clinic. Separate appointments can be scheduled if more in depth services are required.
Please type your initials
to indicate your agreement
to the above statement
*
