Health Certificate

Health Certificate

Client Questionnaire Form
Health Certificates for Travel

Interstate and International
One form per pet, for multiple pets please complete multiple forms individually.

If you already have an appointment scheduled with our Hospital for Health Certificate services please complete this form no later than 48 hours prior to your appointment. This allows our team the time prior to your appointment to fill out records and travel paperwork properly for a smoother and quicker process.

Other resources regarding international travel with country specific details may be
found at: https://www.aphis.usda.gov/aphis/pet-travel

Completion of this form does not guarantee Health Certificate services from Companion Animal Hospital. A member of our team will contact you with assistance following the form submission.
Name

First Name Last Name
Pet Name
Destination of Travel : LOCATION
Date of Departure:

Month Day Year
Date
Are you a current client of Companion Animal Hospital? (current meaning our services used in the last 2 years)

Yes No Previous Client Referred
Have you checked the requirements on the USDA website?

Yes No
Address you are moving FROM:

Street Address

Street Address Line 2

City State / Province, Country

Postal / Zip Code
Phone Contact for the FROM address:
Please enter a valid phone number.
Address you are moving TO:

Street Address

Street Address Line 2

City State / Province, Country

Postal / Zip Code
Phone Contact for the TO address:
Please enter a valid phone number.
If your pet is microchipped what date was the chip implanted:

Month Day Year
Date
Microchip Number: LOCATION
Please have the following supporting documentation prepared for our team to complete Health Certificate services:

- Microchip information/record

-Historical record of all vaccinations for the past 3 years

NOTE: Rabies vaccines must be administered after implantation of the microchip to be valid for overseas travel.
Flying OUT of LOCATION with AIRLINE .
Flying INTO LOCATION with AIRLINE .
Will you be travelling on the same plane as your pet and/or using a pet shipping company?
Should be Empty:

Health Certificate

Health Certificates for Travel