Pet's Information

Pet's Name:

Pet's Age:

Color:

Weight:

Species:

Breed:

Microchip:

Sex

Male
Neutered Male
Female
Spayed Female

Client's Information

Layout

Client's Name

Email: *

Phone Number:

Address:

Address Line 1

Address Line 2

City

State

Zip Code

Destination Information

Address of Final Destination:

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Destination Phone:

Travel Plans

Layout

Date of Departure:

Date of Arrival at Final Destination:

Will you be stopping anywhere other than the final destination?

Will you be traveling with your pet?

Yes
No, my pet will be departing at another time

How will your pet be traveling?

Flying in Cabin
Flying in Cargo
In Car
Other

(Other) Please explain:

Will your pet be traveling with someone other than yourself? *

Yes
No

If YES, please specify:

Health History

Rabies vaccine information is found on pet's rabies certificate; if you do not have that document, you will need to contact your previous veterinary clinic for records. *Please bring rabies certificates to your appointment*

Where was the most-recent rabies vaccination done (if not here)? *

Date of Most Recent Rabies Vaccination: *

Manufacturer:

Serial Number:

Duration:

Expiration Date:

*If a rabies titer test is required for your country of destination, we will need to schedule a separate appointment for this test. The timing depends on your destination. *

Date of Most Recent Other Vaccinations:

DHPP:

Duration of DHPP:

Leptospirosis:

Bordetella:

Influenza:

Lyme:

FVRCP (Feline):

Duration of FVRCP (Feline):

FelV (Feline):

Date of Most Recent Lab work:

Heartworm test:

Results of Heartworm test:

Fecal:

Results of Fecal:

FelV/FIV (Feline) test:

Results of FelV/FIV (Feline) test:

Any Other Tests and/or Treatment:

Microchip

Depending on the destination, we may need the earliest date your pet's microchip was scanned and documented; if the date of microchip placement is unknown, you may need to contact your previous veterinary clinic for records. You will also need to verify if it is 150 compliant (15-digit code). This information can be found on the USDA APHIS Pet Travel website.

Where did your pet get their microchip (if not here)?

Microchip Number:

Date of Microchip Placement:

Additional Information

You must visit the USDA APHIS website (http://www.aphis.usda.gov/aphis/pet-travel) to make sure your pet meets all the requirements for entry at your destination.

International Travel: With the exception of Canada and Mexico, international health certificates must be endorsed by the USDA after we issue it. USDA may take 5-10 business days to complete the process.

To ensure you get your documents back in time for your trip, please schedule your appointment with us within the time frame of the destination. It may take our office 48 hours to complete the certificate for submission to USDA.

HAWAII TRAVEL: Please visit the Hawaii Department of Agriculture's website (http://hdoa.hawaii.gov/ai/aninmal-quarantine information-page/) to make sure your pet meets all the requirements.

AIRLINES: Please be aware that airlines have their own requirements for travel, so in addition to making a reservation for your pet, you will need to make sure that you have all the necessary documents.

Please attach Medical Records

Click or drag files to this area to upload. You can upload up to 5 files.

Signature *

Clear Signature

I acknowledge that | have read through this form in its entirety and have visited the USDA APHIS website to make sure my pet meets all the requirements for entry at my destination. I will also attach and/or email medical records with this form.

Date *

Travel Health Certificate Questionnaire