Veterinary Form 4 - Self-Declaration For Specified Support Substances

ADVERTISEMENT

VETERINARY FORM 4
4
SELF-DECLARATION FOR SPECIFIED SUPPORT SUBSTANCES
(To be used in accordance with Veterinary Regulations, Self-Declaration Substances)
A copy of this form must be provided to the Veterinary Commission/ Delegate prior to the administration of any substance. A copy must also
be supplied to the Person Responsible and be available at all times for inspection if requested by an FEI Steward.
Discipline (please tick as appropriate):
Jumping
Dressage
Eventing
Driving
Vaulting
Endurance
Reining
Para-Equestrian
During the Event (please write location and category):
I _____________________________ (FEI Permitted Treating Veterinarian name) declare that I will use the following medications
(maximum of 3 substances) for:
Horse FEI ID number
Horse’s name:
(or Passport number):
Stable Number:
Person
Country/ National
Responsible:
Competition number:
Federation:
SUBSTANCE
PRODUCT
REASON FOR
DOSAGE
ROUTE
DATE &
DATE &
DATE &
DATE &
DATE &
TIME
TIME
TIME
TIME
TIME
TRADE NAME
ADMINISTRATION
(IM, IV)
Joint Support
Injectable
Vitamins
Amino Acids
Injectable
Homeopathics
Veterinarian FEI ID
Signature of Treating
Number:
Veterinarian:
Date:
Only substance specifically listed in the 2016 Veterinary Regulations, Edition 13, may be administered by means of Self-Declaration with this
Veterinary Form 4.

ADVERTISEMENT

00 votes

Related Articles

Top 20 Happy Easter Cards And Gift Tags To Download For Free
Top Ten Easter Arts And Crafts Activities For Your Kids
Free Easter Coloring Pages And Easter Printables For Your Kids

Related forms

Form 4-6 - Temporary Order Of Support (and Referral To Support Magistrate) Form 4-6 - Temporary Order Of Support (and Referral To Support Magistrate) Legal
Form 4-a - Declaration Of Recommender For Belize Passport Appplication Form 4-a - Declaration Of Recommender For Belize Passport Appplication Life
Form Id - Self-declaration Tax - Province Of Prince Edward Island Form Id - Self-declaration Tax - Province Of Prince Edward Island Financial
Form B Arrearage Worksheet For Spousal Support Or Child Support Form B Arrearage Worksheet For Spousal Support Or Child Support Legal
Form 8b - Consent Order For Child Support Form 8b - Consent Order For Child Support Legal
Form 4 - Work Verification For Lcc Dental Hygiene Program Form 4 - Work Verification For Lcc Dental Hygiene Program Legal
Form 4.0 - Application For Authority To Administer Estate Form 4.0 - Application For Authority To Administer Estate Legal
Form 4-es - Application For Extension Of Time To File Wisconsin Corporation Franchise Or Income Tax Return Form 4-es - Application For Extension Of Time To File Wisconsin Corporation Franchise Or Income Tax Return Financial
Form Lb-0927 - Declaration For Representative Form Lb-0927 - Declaration For Representative Legal
Form Ftb 1144 - Declaration For The Franchise Tax Board Form Ftb 1144 - Declaration For The Franchise Tax Board Financial

Related Categories

Parent category: Medical
Download
Go