Health Certificate Questionnaire

Health Certificate Questionnaire

Please fill out the form below PRIOR to your appointment
Owner's Information
Name *

First Name Last Name
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number *
Please enter a valid phone number.
Email *
example@example.com
Patient's Information
Is this pet currently a patient of this clinic? *

Yes No
Name *
Species *

Cat Dog Other
Breed
Sex *

Male Female
Date of Birth

Month Day Year
Date
Color
Weight
Has the patient been neutered/spayed?

Yes, neutered. No, not neutered.
Rabies Expiration Date

Month Day Year
Date
Check If Rabies Status Unknown
Has your pet been seen at another hospital?
Please list name and phone/email.
Who is traveling with the pet? *
How will the pet be traveling? Air, Car, etc. In cargo, etc. *
Destination Address *
Please include dosages
Date of Travel *

Month Day Year
If a specific date is not available, please pick a date close to what you would like.
Upload your pet's health records here.

Cancel of
Health certificate requirements vary greatly between destinations. Please be diligent and visit the USDA Pet Travel site to learn about specific requirements.

While we will do our very best to guide you in your travel requirements, ultimately, it is up to you to provide the required information and timely planning.

We are a USDA accredited practice and are able to facilitate domestic and international health certification.
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Owner's Information