Veterinary certificate
FE 1646, 838 83 Frösön
0775-88 88 88, +46 8 588 421 00
Examination
requested by
Owner details
Animal details
Who?
Owner
Agria
Purpose
Insurance
Other
Surname, firstname
lnsurance number
Residential address
Country
Postcode
Name
Date of birth
Sex
Breed
Clinical
observations
Neutered
ID-/Registration number
Animal
Dog
Sale/Transfer
new owner
Other
Cat
1
General
condition
Colour and special markings
Bird
2
Temperament
3
Skin, haircoat
4
Palpable
lymphnodes
Good
Reserved
Normal
Aggressive
Red
Generally
enlarged
Conjunctivitis
Poor
Overweight
Normal
Rash
Locally enlarged
Entropion
Emaciated
Other
Papules
Normal
Pustules
Other
Other
Ectropion
11
Reproductive
system
Well muscled
Cryptorchid
General atrophy
Local atrophy
Normal
Spontaneous
coughing
Abnormal
testicle size l.r.
lnguinal hernia
Other
Normal
breathing
Abnormal
breathing
Other
Bite abnormality
Malocclusion
Normal
Other
Other
12
Musculature,
tendons, paws,
and claws
Normal
Normal
Tonsillitis
Exudate
Other
Pos, cough
reflex
Abnormal
sounds on
auscultation
Gingivitis
Swollen
Normal
Nasal discharge
Fractured
tooth/teeth
Chronic
R
Signs af heart
insufficiency
No rectal
examination
Calculus
R
Acute
Heart murmur
Other
Normal
Normal
Other
Prostate
enlarged
R
Mucous membranes normal
lnfection
Tenderness on
palpation
7
Mouth cavity, teeth,
and throat
Red
L
Mucous membranes not
normal
10
Respiratory
system
6
Ears
Otitis
Sores
Parasite
lnfection
Umbilical
hernia
L
R
L
Dandruff
9
Circulatory
system
L
Tumours
Hair loss
8
Abdominal organs,
paipation, and
rectal examination
5
Eyes
Testicular
tumour(s)
Preputial
discharge
Vaginal
discharge
Tenderness
in paws
Claw discomfort
Discomfort on
flexing
shoulder
Patellar luxation
yes
no
Kinked tail
elbow
yes
knee
no
Other
hip
other joints
Lame
yes
13
Skeletal system, ligaments,
and manipulation af joints
no
Pododermatitis
Mammary
tumour(s)
Furunculosis
False pregnancy
Other
Normal
Tenderness on
palpations of spine
yes
no
Normal
Other
Explanation of the note above:
Animal currently on medical treatment:
Agria Djurförsäkring 02.2017. Mustasch Utg 1 466-0099
To the best of the signatory´s knowledge, the animal has previously undergone examination or/treatment for:
By X-ray, ECG, ultrasound, or had a comprehensive eye examination. Results:
General impression/comments
Valid 7 days from the examination
Signature
Place and date
Veterinary surgeon’s signature
Veterinary surgeon’s stamp, clinic address, telephone, e-mail