Apple Valley Animal Hospital

1207 Cedar Creek Grade
Winchester, VA 22602



Vaccination Consent


New Clients, you will need a Client Information, Vaccination Consent, Advance Directive and Staff Hours form filled out prior to your first appointment!

Please forward all previous records to


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Vaccination Consent Form


Many of the diseases your pet should be vaccinated against can be deadly, highly contagious or cause significant illness. Your pet can be exposed to these diseases by coming into contact with other animals or through the environment. Appropriate vaccinations are an important aspect of preventative health care for pets. However, in rare cases some pets may have a reaction to the vaccine that may need medical attention. I understand the risks associated with vaccinating my pets
Owner's Name (required)

Date (required) :
Zoonotic Diseases

There are some diseases your pets can catch which may pass to yourself or your family. These are called Zoonotic diseases. Zoonotic diseases may be spread in different ways. To offset this risk we recommend regular fecal exams for intestinal parasites, keeping your pet’s vaccinations current, and annual wellness exams for other problems such as skin conditions that can be transmitted to your family. I understand the risk of Zoonotic diseases to my family and what protocols my veterinarian has to help protect my family.
Owner's Name: (required)

E-Mail Address (required) :
Owners County (required)

I agree that I have read all of the information provided on this form and that all of the above information I have provided is true. (required)

Yes, I agree

Date (required) :

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