AHTCA Veterinarian Certification
American Hunt Terrier Club Association, INC.
13288 Bean Rd  Alexander, AR  72002
Phone: 5
01-607-4453   Email: ahtcalady@gmail.com
Fill out completely, print and mail to the AHTCA

Terrier's Name: ___________________________________________________ Age: ____________
Owner's Name: ____________________________________________________________________
Address: _________________________________________________________________________
City: ________________________________________ State: _______ Postal Code: ____________
Phone Number: ___________________________ AHTCA Membership # ____________________

Chest Measurement: ______ inches: (at deepest part of the chest behind front legs)
Height at point of withers: __________ inches.
Length of back: ________ inches (measured from base of tail to point of withers)
Coat:   [ ]Smooth      [ ]Rough      [ ]Broken
Teeth:   [ ]Scissors Bite   [ ]Level Bite   [ ]Undershot   [ ]Overshot   [ ]Other (describe)
_______________________________________________________________________________
Nose: [ ] Fully Pigmented Black [ ] Liver colored nose  [ ] Lacking Full Pigment  
[ ] Other explain ____________________________________________________________
Eyes:   [ ]Normal   [ ]No (describe) __________________________________________________
Vision:   [ ]Normal   [ ]No (describe) ___________________________________________________
Iris:   [ ]Brown   [ ]Blue   [ ]Yellow   [ ]Other ______________________________________________
CERF #: ____________________________
Hearing:   [ ]Normal   [ ]No (describe) ________________________________________________
BAER #: ____________________________
Cardiovascular:   [ ]Normal   [ ]No (describe) _________________________________________
Testicles:   [ ]Normal   [ ]No (describe) ____ __________________________________________
Hernia:   [ ]No   [ ]Umbilical   [ ]Iguinal   [ ]Other (describe) ______ _______________________
Legs:  [ ]Normal   [ ]Sub-luxating Patella   [ ]Luxating Patella, Grade _______  Other  _______   
(describe)______________________________________________________________
Feet: (all four toes touching the ground?)   []Normal   []No (describe)  _________________
Surgical Scars (describe): _______________________________________________________
Temperament (toward a non-threatening person):   [ ]Shy   [ ]Normal   [ ]Aggressive
Veterinarian's general opinion: Are there any reasons why this terrier cannot
function as a working dog or be used on the AHTCA breeding program?
_________________________________________________________________________________
_________________________________________________________________________________


Veterinarian's Signature: ____________________________________ Date: _________________

Address: _________________________________________________________________________

Phone: ___________________________________________________________________________