Breed Sex Date of Birth Date of Exam Rabies Vaccination: Date Given Date Expires Veterinary Provider Information Name of Veterinarian Veterinarian’s License Number Address of Veterinarian Phone Number of Veterinarian Dogs and Cats On the above date I completed a health examination on the dog or cat listed above. At that time I certify that the animal in question was healthy. The animal is current on all recommended core vaccinations, including rabies, and there was no evidence of end.
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How to fill out the IA 470-5153 online
The IA 470-5153 form is an essential document for providing a health examination certification for pets under the Iowa Department of Human Services. This guide offers clear, step-by-step instructions to help you complete the form accurately and efficiently.
Follow the steps to successfully complete the IA 470-5153 form online.
- Click 'Get Form' button to obtain the form and open it in the editor.
- Enter the name of the pet owner in the designated field to ensure proper identification.
- Fill in the pet owner's address, ensuring it is accurate for any necessary correspondence.
- Input the name of the pet in the appropriate section to clarify which animal the certification pertains to.
- Select the species of the pet from the options provided to categorize the animal correctly.
- Indicate the breed of the pet to provide specific details that may be needed for identification.
- Mark the sex of the pet to fulfill all requirements concerning the pet's identification.
- Enter the date of birth of the pet in the required format for verification purposes.
- Provide the date of the health examination conducted by the veterinarian.
- Fill in the rabies vaccination details, including the date given and the expiration date, to confirm vaccine compliance.
- Enter the veterinarian's information, including their name, license number, address, and phone number for verification.
- Certify the health examination results by confirming that the animal was healthy and current on vaccinations, as mentioned in the form sections.
- Ensure that the veterinarian comments on the health condition of the dog, cat, or bird accurately based on the examination.
- Obtain the veterinarian’s signature and the date of signing to validate the completion of the form.
- Finally, review all entered information, then save changes, download, print, or share the form as needed.
Complete your IA 470-5153 form online to ensure your pet's health documentation is accurately submitted.
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