Brooklyn Heights Veterinary Hospital International Pet Travel Form

Are you an existing client of Brooklyn Heights Veterinary Hospital?*

YesNo
Please provide an email address we can use to contact you with follow-up information*
example@example.com
If you do not have an email address, please provide a phone number we can use to contact you with follow-up information
Please enter a valid phone number.

Domestic Contact Information

Please provide the name and contact information of the CONSIGNOR (pet owner, or person designated to care for the pet, in the USA)
Consignor Name*

First NameLast Name
Consignor Address*

Street Address

Street Address Line 2

CityState

Zip Code
Consignor Phone Number*
Please enter a valid phone number.
Some documents may need to be shipped from the USDA back to the owner. How would you prefer to receive the documents?*

Ship directly to the domestic address provided aboveShip to BHVH, I will pick it up thereShip to a different address
International Contact Information

Please provide the name and contact information of the CONSIGNEE (pet owner, or person designated to care for the pet, in the DESTINATION COUNTRY)
Please choose one of the following regarding your international contact information*

I have this information nowI do not have this information yet but understand that I must provide it to Brooklyn Heights Veterinary Hospital in a timely manner, prior to my pet's examination
Consignee Name

First NameLast Name
Consignee Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Consignee Phone Number

Country CodeArea CodePhone Number

Pet Details

Please only include information about the pet(s) that will be traveling at this time.
Pet Information*
Does your pet take parasite prevention?*

My pet takes ONLY flea and tick prevention and is up to date.My pet takes ONLY heartworm prevention and is up to date.My pet takes BOTH flea and tick and heartworm prevention, and is up to date.My pet has taken parasite preventatives in the past, but is not up to date.My pet has never taken parasite preventatives.Other
If you have medical records for your pet(s) that we might need, please attach them here.

If you are a new client, this would be full medical records. If you are an existing client but your pet got its rabies vaccine or other relevant vaccines or testing completed at another vet, please upload those records here.
Cancelof
If you do not have medical records but think we may need them, please give us the contact information of any veterinarian your pet has visited in the last 3 years.
Is there any further information you would like to provide about your pet(s)?

Domestic Contact Information