Kentucky Board of Veterinary Examiners


II. Registered Responsible Party† First Name


Last Name


KBVE Application for Veterinary Facility Registration Application for Veterinary Facility Registration


Date of Birth Mailing Address


Phone


Email


III. Veterinarian Manager† First Name


Last Name


KBVE License No. Phone


Email


†NOTES: 1) Attach additional pages as needed. 2) Pursuant to 201 KAR 16:767, Section 4(1), notification of any change to the registered responsible party shall be sent to KBVE within 30 days. 3) Pursuant to 201 KAR 16:767, Section 4(2), notification of any change to the veterinarian manager shall be sent to KBVE within ten (10) days.


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


Lexington, Kentucky 40511 40


Page 2 of 6


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


KVMA News | Spring 2025


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