Pet Owner Worksheet Intl Health Certificate

Pet Owner Worksheet for Preparing for Your Visit with an Accredited Veterinarian to Complete Health Certificate

Please share the details of your upcoming travel plans so we can carefully review your destination country's requirements on your behalf. Once we receive your form, a dedicated travel team specialist will personally reach out within 7 days to guide you through the next steps.
If you are traveling sooner than 14 days, please complete this form AND call our office so that we may assist you in a timely manner: 410-822-8505
Are you a new client?
Are you traveling WITHIN the next 14 DAYS from TODAY'S date?
Important Information

Please note that if your departure date is within the next 14 days, we cannot guarantee that we will be able to assist with your travel inquiry. A team member will reach out to confirm your request.
I have read the above statement and understand that my health certificate may not be completed within 14 days due to various circumstances.
Name (as it appears on your passport or government issued ID)

First NameLast Name
Address (in the US)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
List the destination country you are traveling to with your pet
Who will be accompanying your pet while traveling?
List the Address(s) and Phone Number(s) in the Destination Country where your pet will stay during the visit:
How is your pet leaving the United States?
If your pet will be laying over (travel by air) or stopping (travel by boat) in other countries on the way to the destination. List those countries:
What Date is your pet LEAVING the United States?

MonthDayYear
Date
WHERE is your pet departing the United States from (last air or sea port)?
Provide the date that your PET will Arrive in the destination country

MonthDayYear
Date
Provide the date that YOU will Arrive in the destination country

MonthDayYear
Date
How many pets are traveling?
Pet Name
How old will the pet be on the date of travel?
Pet Sex
Is your pet Spayed/Neutered?
What type of pet(s) will be traveling?
What is your pets Date of Birth?
If unknown, please put approximate age
What Color is Your Pet?
Does your pet have a microchip?
Microchip Implant Date

MonthDayYear
Date
Who administered your pets last Rabies Vaccination?
On what date was your pet last vaccinated for Rabies?

MonthDayYear
Date
Please email your pet's current medical records to: Operations@vmceaston.com. Alternatively - please provide name and phone number of your Veterinary Hospital so that we may call to request records.
Does your destination country require an Import Permit?
Have you booked your Flight/Cruise?
Did your airline or cruise ship give you any additional travel requirements for your pet?
Does your pet have a European Union Pet Passport?
Are you Moving Permanently?
I hereby authorize the veterinarian to examine, prescribe for, or treat the above described pet(s). I assume responsibility for all charges incurred in the care of my pet(s). I also understand that these charges will be paid at the time of release and that a deposit may be required for surgical treatment or hospital treatment.
I certify that I am the legal owner/agent of the above mentioned pet(s) and I am hereby assuming all financial responsibility for treatment given to this animal by Veterinary Medical Center.
I hereby authorize the release of my pet's medical records to another facility (boarding/daycare, insurance company, urgent care facility, etc) should they be requested.
I acknowledge that my pet currently is, or will be, older than 6 months when/if re entering the US
I understand that certain destinations, airlines, and airports may have their own specific requirements regarding service animals. It is my responsibility to verify and comply with those requirements before arranging my travel. Veterinary Medical Center does not track or monitor the service animal policies of individual airlines, airports, or destination.
International pet travel requirements are continually evolving, and we make every effort to stay fully informed about both your destination country's requirements for obtaining health certificates and the United States' requirements for re-entry. Please be aware that some countries may impose additional requirements for pets departing from their country that are not reflected in USDA guidance. For this reason, we strongly recommend contacting the airport authorities in your destination country to confirm whether any additional steps will be required prior to departure.
Signature
Today's Date

MonthDayYear
Date
Should be Empty:

Pet Owner Worksheet for Preparing for Your Visit with an Accredited Veterinarian to Complete Health Certificate

Important Information