Fit to Fly Certificate
Examination Details
- Date of examination
- Time of examination
Client Details
- First name
- Last name
- Phone
- Patient ID
- Address
Patient's Details
- Name
- DOB (age)
- Microchip
- Weight (kg)
- Gender
- Desexed
- Species
- Dog
- Breed
- Colour
- Markings
History
Does this dog have a history of the following conditions?
- i. Dyspnoea
- ii. Abnormally increased respiratory noise
- iii. Exercise intolerance
- iv. Syncope
- v. Poor heat tolerance
- vi. Heat stroke
- vii. Surgical correction of Brachycephalic Obstructive Airway Syndrome (BOAS)
Body Condition Score
- Body Condition Score (1-9)
Respiratory Noise
- Does this dog have upper respiratory tract noise (stertor) at rest that is clearly audible without the use of a stethoscope?
Nasal Airflow Assessment
- Is the dog still open-mouth breathing after 10 minutes in the consult room with the air conditioning set to 22°C?
Veterinary Certification
I, the undersigned veterinary practitioner, examined the above dog on the date shown and certify that the findings recorded on this certificate are true and accurate at the time of examination.
- Veterinarian name
- Registration number
- Practice name and address
- Phone
- Date signed
Veterinarian signature
Clinic stamp
