Application for Health Certificate Exams

Application for Health Certificate Exams (Please note that preparing for travel to some countries can take months)
Do you need an International or Domestic Health Certificate?
Name (First, Last)
Phone Number

Area Code Phone Number
Email Address
example@example.com
Origination

Information of where you are currently residing
Address (Physical)
City
State
Zip Code
Pet(s) Information
Pet's Name *
Species *
Breed *
Age/Date of Birth *

Month Day Year
Date
Microchip number (if required by the destination country)
Microchip Implantation Date

Month Day Year
Date

Enter Additional Pet
Pet's Name
Species
Breed
Age/Date of Birth

Month Day Year
Date
Microchip number (if required by the destination country)
Microchip Implantation Date

Month Day Year
Date

Destination and Travel Information
Date of Travel

Month Day Year
Date
Destination Country or State
Destination Address
Will your pet be returning to the US?

Yes No
Which Airline will your pet be flying with?
How will your pet be flying?
Destination Country Requirements
Is your pet current on all vaccinations required by the destination country and were the vaccinations given within the required timeframe?

Yes No
***You must include your pet's vaccination history and original SIGNED rabies certificate (current or most recent) with this application if the vaccines were NOT administered by Owl Creek Veterinary Hospital. Does the destination country require any lab tests / blood work? If YES, what tests are required and when must the samples be collected? (Please list)
If YES, what tests are required and when must the samples be collected? (Please list)
**Please note that samples will need to be collected within the testing timeframe required by your destination country and some tests may take a long time for the results to be returned. Some countries require a waiting period after testing and before entry into the destination country***
Does the destination country require any treatments such as internal/external parasite control?

Yes No
How many days prior to travel must the exam be completed by?
Does your airline have any of its own specific requirements?

Yes No
If YES, what is required (please list)
After your application is submitted to Owl Creek Veterinary Hospital, we will review it and get back to you as soon as we are able. We appreciate your patience.
Should be Empty:

Origination

Pet(s) Information

Destination and Travel Information