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Paul & Kathi Wilson
141 Winston Sec. Rd.
Winston, OR 97496


Mocha#1 Excelsiors Havanese Puppies             Latte_1

Excelsior’s Havanese
Winston, Oregon


As a condition of sale and warranty coverage.

This Veterinarian Examination Form is to be filled out by your Vetand mailed or e-mailed
back to Excelsior’s Havanese Puppies(paul.sodhoppers@q.com), along with a copy of the Bill,
within 14 days of the arrival of your puppy.
Failure to comply with these conditions will Void the Entire Warranty - No Exceptions.

Please Check all that apply and fill in all blanks as specified.


Bright/Shiny Good Condition _____ Abnormalities Noted ____________________________

PARASITES PRESENT (All puppies leave my home with no Fleas Ticks or Lice) if they are
present provide Frontline or Advantage Plus at this visit and instruct client on care

Present at exam Fleas ____ Ticks ____ Lice ____
Other Lesions Noted _____________________________________________________________

EYES Clear ____ Odor Free ____ Discharge ____ Red ____
Abnormalities Noted ______________________________________________________________

LUNGS Clear ____ Coughing ____ Congested ____
Abnormalities Noted ______________________________________________________________

HEART Normal Rhythm ____ Murmur ____ Grade ____
Is Testing Required, if so what _____________________________________________________

UROGENITAL Normal Non Painful ____ Testicles Present (Males Only)____
If not check for scar to see if Neutered or noted on health certificate. Notes____________________________________________________________________________

LEGS, JOINTS, PAWS Normal non Painful ____ Limping ___ If limping when was it reported
to you ___________________________________________________________________________

Results of x-ray if required?


NORMAL ____ ABNORMAL ____ Please Explain if abnormal
and not listed on vet health shipping certificate.__________________________________________________________________________________

NEUROLOGICAL BEHAVIOR Normal Puppy behavior ____ Lethargic ____
Abnormalities Noted ________________________________________________________________

FECAL EXAMINATION Negative ____ Positive ____ For _________________________________
Treatment Provided ________________________________________________________________

OVER ALL CONDITION EXCELLENT ____ GOOD ____ FAIR ____ PLEASE EXPLAIN ___________________________________________________________________________________

Do you find this puppy fit for purchase by your client? YES ____ NO _____
If NO - Please DO NOT TREAT.
Have the clientContact us immediately to make arrangement to have the puppy returned for a
refund or replacement as per the Contract Guarantee. 
Please explain in detail ______________________________________________________________ ___________________________________________________________________________________

Please Note The Buyer has been provided a Health Record of all past vaccines and worming.
The puppy will also have a Veterinarian Examination Health Certificate,if the puppy was
shipped. Both documents should be provided to you or staffat this first visit.

Puppy is current on Vaccines at time of new owner possession, but may be due for boosters. Please look over the Health Records and administer any needed vaccinations during this visit.  It is one of the requirements that on this visit the client be educated on the care and treatment of heart worm andflea/tick control, SPAYING, NEUTERING. All puppies 12 weeks and older per our warranty agreement are to be started on heart worm control.
Although your area may not be susceptible to heart worm, I still recommend HEARTGARD for all our Havanese because this is an area of concern for this particular breed.  It is a small price to pay for ongoing health and peace of mind.

CLIENTS NAME ____________________________________________________________________
CITY ___________________ STATE ___________

NAME OF DOG __________________ BREED ______________________ DOB _________________
SEX _________ COLOR ______________________________________________________________

Thank you very much for taking the time to honor this request.

VET SIGNATURE____________________________________________________________
LIC. #______________________