Kentucky Board of Veterinary Examiners


KBVE Application for Veterinary Facility Registration Application for Veterinary Facility Registration


I hereby state that the information contained herein and attached to this application is true and accurate to the best of my knowledge, and that should the Kentucky Board of Veterinary Examiners determine that any statement herein is false, I acknowledge the Board may suspend, revoke, or terminate any credential issued by the board.


I swear or affirm that I am not omitting any information which might be of value to this Board or its determination of my qualifications, whether it is requested or not and I agree that any falsification, omission, or withholding of pertinent information or facts in regard to my application shall serve as sufficient grounds for the denial, revocation, cancellation, or suspension of my facility registration.


Further, I understand that the registered facility and all employees of and those contracted with the facility are required to abide by KRS Chapter 321 and 201 KAR Chapter 16. For direct links to the statutes and administrative regulations that shall govern the facility’s activities, I am aware I can review the materials by visiting the KBVE website at https://kbve.ky.gov/Pages/practice-act.aspx.


I hereby swear or affirm, that I have read the above statements and agree to the same.


_____________________________________ ___________________ Signature


Date


_____________________________________ _________________________ Printed Name


Title


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


Lexington, Kentucky 40511 44


Page 6 of 6


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


KVMA News | Spring 2025


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