Health Clinic

Deadline: October 21, 2026

2026 HEALTH CLINIC REG FORM Download

2026 Health Clinic Form

AKC Registered Name(Required)

Call Name

AKC #(Required)

DOB(Required)

Sex(Required)

Microchip #(Required)

PLEASE NOTE: A microchip is required for the health clinic to submit results.

IF you do not already have your dog microchipped please put “purchasing” in this field and down below purchase a microchip.

IF your dog is already microchipped you are REQUIRED to put their microchip serial number.

Date of Last Routine Vaccination(Required)

Sire's AKC#(Required)

Dam's AKC#(Required)

Owners Name(Required)

Owners Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email(Required)

Phone(Required)

Health Clinic Services

Thyroid Panel – $50

AKC/DNA – $30

AKC ISO Microchip – $25

OFA/CHIC/DNA Repository – $15

Non-English Setter

Thyroid Panel – $84

Total

Credit Card

Card Details

Cardholder Name