KBVE Application for Veterinary Facility Registration


KENTUCKY BOARD OF VETERINARY EXAMINERS 4047 Iron Works Parkway, Suite 104, Lexington, KY 40511


Office: 502-564-5433  Fax: 502-753-1458 kbve.ky.gov  vet@ky.gov


Application for Veterinary Facility Registration OFFICIAL USE ONLY


Instructions: This application shall be completed by a registered responsible party or veterinarian manager in order to apply for a veterinary facility registration in Kentucky pursuant to KRS Chapter 321 and 201 KAR Chapter 16. Completion of all fields on this application is mandatory. Insufficient answers or omissions will be sufficient grounds for rejection of this application. Review the check list at the end of the application to ensure your submission is complete. Print SINGLE SIDED; DO NOT staple.


KRS 321.181(57) states, “‘Registered responsible party’ means at least one (1) person who: (a) … is designated as the registered responsible party on a facility registration and is responsible for its operation and management in conjunction with the veterinarian manager or allied animal health professional manager; and (b)… At a minimum, the registered party shall include all persons, owners, and corporate owners of the registered veterinary facility or allied animal health professional facility”. KRS 321.181(68) states, “‘Veterinarian manager’ means at least one (1) Kentucky-licensed veterinarian who registers to assume responsibility for the registration, management, and operation of a registered veterinary facility”.


I. Veterinary Facility Contact Information Name of Veterinary Facility / Business


Facility Website Facility Phone Number Facility Email Address


Primary Facility Type  Fixed Facility  Mobile Unit


Address Type Mailing Address


Physical Premise Address (If primary mobile unit, parking address)


REQUIRED ATTACHMENT  Secretary of State Business Registration


Has this facility previously applied for or been registered as a veterinary facility with the Kentucky Board of Veterinary Examiners?


If yes, provide the dates of previous application(s) and registration(s).


Submit Complete Application to: Kentucky Board of Veterinary Examiners 4047 Iron Works Parkway, Suite 104


Lexington, Kentucky 40511 KVMA News | Spring 2025 Page 1 of 6


Form Last Updated: 2/2025 MIR: 201 KAR 16:762


39  Yes or  No Street


If one (1) or more additional mobile units being registered with this facility, indicate quantity:


City Zip


________ County


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