Owner Information

Please complete the below information for the owner of the animal, as you would like it to appear on the OFA certification.

Name *

First

Middle

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone Number *

Email Address *

The OFA results will be emailed to you approximately 4-6 weeks after the x-rays have been submitted by SFVC. The OFA no longer mails hard copy certificates.

Any other co-owners first & last names

Patient Information

Registration Status (check all that apply)

Not Registered
American Kennel Club
United Kennel Club
Other

If other, explain

Registration Number(s)

(separate with comma)

Registered Name

Call Name

Sex

Male
Female

Date of Birth

Is this pet up to date on a rabies vaccine?

Yes
No

What date was the last rabies vaccine given on?

Please have the rabies vaccine updated prior to the date of the appointment. If the pet is not up to date on the day of the appointment, SFVC will administer a rabies vaccine.

Is this pet microchipped?

Yes
No

What is the microchip number?

Dr. Sondel will microchip the pet prior to taking the x-rays, as SFVC requires all dogs to be permanently identifiable via microchip prior to OFA x-rays being taken.

Dam’s registration number, if applicable

Sire’s registration number, if applicable

Appointment Information

From the list below, please select which OFA tests you would like performed at this appointment

My signature below signifies that all the above information is true and accurate to the best of my knowledge. I understand that failure to provide this information prior to the day of my appointment may result in additional charges.

Name

Signature

Clear Signature

Upload rabies certificate/proof of rabies

Click or drag files to this area to upload. You can upload up to 5 files.

Upload image of certification

Click or drag files to this area to upload. You can upload up to 5 files.

West Madison Clinic

East Madison Clinic

Phone

Sondel Family Veterinary Clinic

OFA Questionnaire