N.Y. Comp. Codes R. & Regs. tit. 1 § 81.2
Upon the examination of a dog or a cat which is subject to the provisions of section 742 of the General Business Law, the examining veterinarian shall provide the consumer with the following form which shall also include the notice set forth in section 81.4 of this Part.
VETERINARY CERTIFICATION OF
UNFITNESS OF DOG OR CAT FOR PURCHASE
TYPE OF ANIMAL: ________ CAT ________ DOG (check one)
BREED:
AGE:
SEX:
COLOR:
DATE OF EXAMINATION:
DIAGNOSIS:
TREATMENT RECOMMENDED:
ESTIMATE OR ACTUAL COST OF TREATMENT:
OWNER OF CAT OR DOG:
COMPLETE ADDRESS:
TELEPHONE NUMBER:
This is to certify pursuant to Article 35-B of the General Business Law of the State of New York, that I am a veterinarian duly licensed by the State of, that I have examined the above animal as set forth herein and that I find that said animal is unfit for purchase due to: ________ illness; ________ a congenital malformation which adversely affects the health of the animal; or ________ the presence of symptoms of a contagious or infectious disease (check one).
Date: ________
____________
Signature
REMARKS:
Name of Veterinarian:
Address:
Telephone Number:
N.Y. Comp. Codes R. & Regs. Tit. 1 § 81.2