Health Certificate Travel Form
Owner (Name)
First Name
Last Name
Name of Person Flying with Pet
First Name
Last Name
Pet (Name)
First Name
Last Name
Current Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Destination Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Airport
Airline
Will your pet by flying with you in the cabin or in cargo?
Cabin
Cargo
Date of Departure
-
Month
-
Day
Year
Date
Is your pet on heartworm and/or flea prevention?
Yes
No
What prevention is your pet on? (Check all that apply)
Heartgard Plus
Sentinel Spectrum
Interceptor Plus
Sentinel
Interceptor
Advantage Multi
Trifexis
Simparica
Simparica Trio
NexGuard
Bravecto
Credelio
Frontline Plus
Revolution Plus (Cat)
Tri-Heart
Revolution
Other
If 'other', please specify.
Does your pet have a microchip?
Yes
No
If your pets last rabies vaccine is still current and was NOT given at EaDo Veterinary Clinic, would you be able to provide us with a signed physical copy of the rabies certificate?
Yes
No
Unsure
If 'Yes', please upload a PDF version of the rabies certificate or a picture. Please bring a physical copy of the certificate to your appointment.
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If 'No' or 'Unsure,' please provide us with the clinic's information so we can contact them for records.
If you have any questions or comments, please note them on the text box below and we will address them on the day of the appointment.
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