Pet Owner Worksheet for Preparing for Your Visit with an Accredited Veterinarian to Complete Health Certificate
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Pet Name
List the destination country you are traveling to with your pet
blanks
*
Who will be accompanying your pet while traveling?
The Owner
A person authorized by the owner
No one
A pet transport company is transporting the pet
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?
Air - Direct Flight
Air - Layovers in another country. (List Country(ies) in the next section.)
Car
Train
Boat - Direct
Boat - Cruise Ship. (List Country(ies) that the ship is stopping at in the next section.)
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?
-
Month
-
Day
Year
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
-
Month
-
Day
Year
Date
Provide the date that YOU will Arrive in the destination country
-
Month
-
Day
Year
Date
How many pets are traveling?
How old will the pet be on the date of travel?
What type of pet(s) will be traveling?
Dog
Cat
Ferret
Bird (other than: chicken, dove, duck, goose, grouse, guinea fowl, partidge, pea fowl, pheasant, pigeon, quail, swan or turkey)
Rodent
Hedgehog/Tenrec
Rabbit
Reptile
Amphibian
Does your pet have a microchip?
Yes (provide the implant date in the box below)
Yes - But I don't know the implant date
I have more than one pet, but not all have microchips
No
I don't know
Microchip Implant Date
-
Month
-
Day
Year
Date
Who administered your pets last Rabies Vaccination?
The veterinarian issuing my international health certificate administered my pet's last rabies vaccination.
A veterinarian other than the veterinarian issuing my international health certificate administered my pet's last rabies vaccination. I will provide the last valid rabies certificate PRIOR to my appointment.
I don't know.
My pet is not vaccinated for rabies.
On what date was your pet last vaccinated for Rabies?
-
Month
-
Day
Year
Date
Does your destination country require an Import Permit?
Yes
No
I don't know
Did your airline or cruise ship give you any additional travel requirements for your pet?
Yes - I will provide this information to the veterinarian issuing my international health certificate PRIOR to the appointment.
No
Submit
Should be Empty: