International Travel Exam Questionnaire: The Village Veterinarian

Pet International Health Certificate Questionnaire
In preparation for your pet's travel to Destination*, we request that you complete the following questionnaire and return it to us as soon as possible. The requirements for traveling with a pet vary from country to country and, in some cases, are very strict. Providing us accurate and complete information will ensure a successful and low-stress trip for you and your non-human family members! Please type in all capitals.
YesNo
What is your current address?*
The OwnerNo One (in Cargo)Pet Transport CompanyOther
Name of person traveling with pet:*
Please list the FULL address of the destination country you will be traveling to:*
Pet Owner Phone Number*
Format: (000) 000-0000.
International Tel: (if any)
Format: (000) 000-0000.
Date of your flight*

MonthDayYear
Date
Time of your flight*

Hour Minutes

AM/PM Option
Airline Company:*
Leaving from which Airport:*
Arrival Date*

MonthDayYear
Date
Arrival Time of your flight*

Hour Minutes

AM/PM Option
Name of pet (s)*
Age*
INTACT MALEMALE NEUTEREDINTACT FEMALEFEMALE SPAYED
YesNo
Date of Microchip implantation:*

MonthDayYear
Date
Date of every rabies vaccination: (since pet was born)_*
Copies of each rabies vaccine certificate

Cancelof
Name of Heartworm Medication your pet is on*
Name of Flea and Tick Medication your pet is on*
YesNo
Date of last fecal test*

MonthDayYear
Date
Results of last fecal test*
*** Please remember to always check with the airline to ensure that you/your pet meet their requirements as well. If there is additional documentation needed, then you must provide that to us.
Should be Empty:

Pet International Health Certificate Questionnaire