Veterinarian's name, address, and telephone number

Client's name, address (home or business), and telephone number

Date of VFD issuance

Premises where the animals specified in the VFD are located

Name of the VFD drug(s)

Concentration of VFD drug(s) in the feed, and duration of use

Number of refills authorized, if permitted by the drug approval

Withdrawal time, special instructions, or cautionary remarks

Species and product class of animals

Approximate number of animals to be treated by the VFD before the expiration date on the VFD

Indication for which the VFD is issued

Statement: "Use of feed containing this veterinary feed directive (VFD) drug in a manner other than as directed on the labeling (extra-label use), is not permitted."

An affirmation of intent for combination VFD drugs as described in 21 CFR 558.6(b)(6)

Expiration date of VFD (up to 6 months or as specified on drug label)

Veterinarian's electronic or written signature