International Health Certificate Exam Information Form

Information for North American Health Certificate Exams (Continental United States and Canada)
Name (First, Last)
Address (Physical)
State
City
Zip Code
Phone Number
Email Address
example@example.com
Pet Name
Species
Breed
Age/Date of Birth

MonthDayYear
Date
Microchip number (some destinations require microchip placement)
Destination State
Address where your pet will be staying
Date of Travel

MonthDayYear
Date
How will you be travelling? (If flying please list airline.)
Destination Requirements
***You must include your pet's vaccination history and Rabies certificate with this application if the vaccines were NOT administered by Midway Veterinary Hospital.*** Medical records can be uploaded below.
File Upload

Cancelof
After your application is submitted to Midway Veterinary Hospital, we will review it and get back to you as soon as we are able, depending on destination of travel and completeness of medical records provided the review process will take between 24 and 48 business hours. We appreciate your patience.
Should be Empty: