Application for Post-Exposure Treatment - Potential ABLV Exposure

Your details

Your Name*

First Last

Address*

Street Address Suburb State Post Code

Email*

Enter Email Confirm Email

Phone*

Pet Details

Pet Name*

Breed

Date of Birth*

Species*

Sex*

Male

Female

Desexed*

Yes

No

Microchip Number

If you know your pets number

Exposure Details

Date of Exposure*

Approximate Time of Exposure*

:

Is the bat available or has it been submitted for testing*

Yes

No

Details of Exposure*

Please Enter the name of your current Vet surgery*

Only required if not Kalinga Park

Consent

Nobivac inactivated rabies vaccine is not registered for general use in Australia; however, it may be used under APVMA permit (PER14236) to provide post-exposure prophylaxis to animals following potential exposure to Australian bat lyssavirus (ABLV). The permit requires authorisation, on a case-by-case basis, from a state/territory Chief Veterinary Officer before the rabies vaccine can be used for this purpose. We will apply to the Department on your behalf. Do you consent to us providing your details and your pets details to the department for the purposes of completing the permit. Your pets details will be recorded on a database of pets that have recieved a rabies vaccine.

Signature*

Application for Rabies Vaccine - Potential ABLV Exposure

ABLV Post Exposure Application Form

Your details

Pet Details

Exposure Details

Consent