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Get NJ VPH-28 2012-2024

Rint) Telephone Number Street Address City, State, Zip Animal Name Sex Species Age Breed Color(s) Neutered Male Female Yes No Weight The animal described above has been examined by me on: and I have determined that it would be medically contraindicated to vaccinate this animal due to an infirmity, other physical condition, or regimen of therapy. Describe nature and duration of infirmity, other physical condition, or regimen of therapy: PLEASE NOTE: A reluctance.

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