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Health Certificate Information Sheet
Name
*
First Name
Last Name
Pets Name
*
Address leaving from:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Address going to:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date of departure:
*
-
Month
-
Day
Year
Date
Cargo/Cabin? Truck & Trailer?
*
Cargo
Cabin
Driving
Airline/Shipper:
*
Flight Number
If applicable
Port of Entry/Border Crossing:
If applicable
Purpose for Travel:
*
Has your pet been seen at other veterinary facilities? If yes, please list them:
*
Signature
*
Clear
Submit
Should be Empty: