Pet Health Certificate Form
Required for any animal requiring a health certificate. This form MUST be filled out prior to your appointment. Inspection date must be within 10 days of travel. Please also contact your method of travel for more info. Please make sure when traveling to Hawaii or another country, you check all requirements BEFORE you get a health certificate. You can find that information here: https://www.aphis.usda.gov/aphis/pet-travel/take-pet-to-foreign-country. Hawaii https://hdoa.hawaii.gov/ai/aqs/aqs-info/
Pet Owner's Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Pet #1 Name
Pet #1 Birthdate
Pet #1 Species
Canine
Feline
Other
Pet #1 Gender
Male
Male Neutered
Female
Female Spayed
Pet #1 Predominant Breed
Pet #1 Color
Pet #1 Microchip#
Is this pet being transferred to a new owner?
Yes
No
Receiver's name if not Owner
First Name
Last Name
Pet #2 Name
Pet #2 Birthdate
Pet #2 Species
Canine
Feline
Other
Pet #2 Gender
Male
Male Neutered
Female
Female Spayed
Pet #2 Predominant Breed
Pet #2 Color
Pet #2 Microchip#
Is this pet being transferred to a new owner?
Yes
No
Receiver's name if not Owner
First Name
Last Name
Owner's Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Travel Destination Address (PO BOXES not allowed)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Purpose of travel/movement:
Travel Date:
Return Date (if applicable)
Method of Travel:
Air
Car
Train
Other
Carrier name (i.e. Southwest, Amtrak)
Flight number-required to be filled out if flying
Is your pet flying in the cabin or cargo?
Port of entry if driving or which border crossing
Pet #1 Vaccination (if done elsewhere, email records prior to appt to bouldercreekveterinaryclinic@gmail.com
Date Given
Date Expires
Distemper
Rabies
Bordetella
Leptospirosis
Influenza
FVRCP
FELV
FIV
Pet #2 Vaccination (if done elsewhere, email records prior to appt to bouldercreekveterinaryclinic@gmail.com
Date Given
Date Expires
Distemper
Rabies
Bordetella
Leptospirosis
Influenza
FVRCP
FELV
FIV
Please upload any previous vet records you have here:
Browse Files
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of
Owner signature stating all information is true and correct
Submit
Should be Empty: