International Health Certification Questionnaire
Pet Name
Name of Owner Traveling with Pet
First Name
Last Name
Travel Location
Travel Dates
Current Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Current Phone Number
Please enter a valid phone number.
Address at Travel Location
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number at Travel Location
Please enter a valid phone number.
List Veterinary Hospitals Seen by Pet (so we may obtain records):
Have all travel requirements been completed? This may include vaccinations, microchipping, deworming, and additional blood tests.
Yes
No
Unsure
Submit
Should be Empty: