Healthcare Certificate Form

Please note that preparing for travel to some countries can take several months. Specific guidelines for your destination of travel can be found here on the USDA Website. Complete this worksheet at least 24 hours BEFORE your appointment with our USDA accredited veterinarian for your pets' health certificate.

Pet/s Name (include all pets needing a health certificate)

Name of person traveling with/sending pet:

Are You:

Email Address:

Current Address:

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Current Phone Number:

Name of person receiving pet:

Destination Address:

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

COUNTY (IF IN THE US):

Destination Phone Number:

Import type:

Will you be transitioning to a 3rd country, if so, what country?

US Port of Departure (The place where your pet will be leaving the U.S.)

Departure Date:

Port of Entry (Where you will enter your destination country, if applicable)

Arrival Date:

Method of Travel:

For international travel, please provide the following documents if they were not performed by our hospital:

A valid rabies certificate for your pet's last 2 rabies vaccines
Record of your pet's microchip placement

I acknowledge that I will bring the above documents to my appointment.

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Healthcare Certificate Form

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