Health Certificate Pre-Appointment Form

Please fill out the below information to the best of your ability. This form must be completed prior to your international health certificate/consult appointment.

Owner Name

First NameLast Name

Owner Phone Number

Please enter a valid phone number.

1. List the destination country you are traveling to with your pet.

2. Who is accompanying your pet while traveling?

The OwnerA person authorized by the ownerNo oneA pet transport company

List the address(s) and phone number(s) of your current location and the country where your pet will stay during the visit.

Ship from

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Country

Telephone

Airport

Ship to

Address

Street Address

Street Address Line 2

CityState / Province/Canton/Sector

Postal / Zip Code

Country

Telephone:

Airport

Airline

4. How is your pet leaving the United States (air, car, boat etc)?

List the country or countries your pet will land in before the destination country is reached.

5. What date is your pet leaving the United States and from where (last air or seaport in the US)?

Date

6a. Provide the date YOU arrive in the destination country?

Date

6b. Provide the date YOUR PET arrives in the destination country?

Date

7. How many pets are traveling?

How old will the pet be at the date of travel?

9. What species of pet will be traveling?

10. Does your pet have a microchip?

Yes (list implant date below)Yes, I don't know when it was implanted but I will find outI have more than one pet but not all of them have microchipsNo

a. Microchip implanted on:

When was your pet's 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 need to bring the last valid rabies certificate to my appointment.I don't know.My pet isn't vaccinated for rabies.

I understand that if the last Rabies vaccine was not done at North Austin, I must bring a copy of the Rabies certificate to my appointment.

11. When was your pet's last rabies vaccination?

Date

Does your destination country require an import permit?

YesNoI don't know but will find out before I travel.

Did your airline or cruise ship give you any additional travel requirements for your pet?

Yes, I will give to the veterinarian issuing my international health certificate.No

I have received, understand and signed the disclaimer form.

YesNo, I understand this needs to be done before the Health Certificate.

Signature

Clear