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Birth: yes Breeder? no Patient details: Name: Microchip No: Species: Date of microchipping: Breed: Location of microschip: Coat colour / type: (EU) Pet passport No: male Sex: Date of birth: female neutered Last vaccination date: Last deworming date: Weight: Tattoo: right: Known allergies (medicine): left: Presenting problem: Chronc diseases: How did you hear about us? friends / circle of acquaintances Internet phone book / yellow pages miscellaneous: Please do not hesita.

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