Health Certificate Questionnaire

Health Certificate Questionnaire
Where Are You Traveling To?*
This will determine what type of Health Certificate you need

International/Hawaii
**Before submitting the form, please ensure that all information is accurate.**
These certificates require extensive advanced preparation, therefore an additional fee will incur if last minute changes need to be made at the time of the appointment, as the entire certificate will need to be recreated.
Your full name*
Name of person traveling WITH the pet. This will be the only name on the health certificate.
Your Home Address (or place that you are DEPARTING from)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Your email*
Your phone number*
Your DESTINATION Address (where you will be staying). This is required on the certificate. PO Box is NOT acceptable.*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Scheduled Flight Date*

MonthDayYear
Date
Airline*
Port Of Entry*
PATIENT DETAILS
Patient name*
Patient breed*
Age*
Approximate age or birth date if known
Patient is a*

Spayed FemaleNeutered MaleIntact FemaleIntact Male
Will your pet be in cargo or the cabin?*
Have you been in contact with the airline about pet's travel?*

YesNo

END
Please sign here to acknowledge that you have read ALL requirements for the location you are traveling to, and have obtained all necessary documents requested prior to your appointment with us.*

Clear
Please upload any files or pertinent medical records:

Browse Files

Cancelof
Should be Empty:

PATIENT DETAILS