Health Certificate

Health Certificate
Pet Name*
Age of Pet*
Sex*
Spayed/Neutered*
Breed*
Microchip?*

YesNo
Microchip Number
Shipping Information
Name of Person*
Name of Organization*
Email of Person*
example@example.com
Email of Organization
example@example.com
Phone Number of Person*
Please enter a valid phone number.
Phone Number of Organization
Please enter a valid phone number.
Address Pet is being shipped from

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name of Person that is traveling with pet (Co-Signee)
Name of Organization that is traveling with pet (Co-Signee)
Shipment date / When the pet is leaving
Receiver Information
Name of Person*
Name of Organization*
Email of Person*
example@example.com
Email of Organization
example@example.com
Phone Number of Person*
Please enter a valid phone number.
Phone Number of Organization
Please enter a valid phone number.
Address Pet is going to*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Transportation Method*
Name of Business/organization for transportation*
Email of transporter*
example@example.com
Phone Number of transporter*
Please enter a valid phone number.
Address of Pet transporter *

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
*For air travel, the Airline is the business name & the airport from which pet is leaving from is where address & phone number will come from*
Should be Empty:

Shipping Information