Pet Owner Questionnaire for an International Health Certificate
Your Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Pet's Name
*
Type of pet?
*
Please Select
Dog
Cat
Rabbit
Bird
Rodent
Amphibian
Reptile
Destination country
*
Who is accompanying your pet while traveling?
*
Please Select
The owner
A person authorised by the owner
A pet transport company is transporting the pet
No one
Name of person or company
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How is your pet leaving the United States?
*
Please Select
Air - Direct Flight
Air - Layovers in another country.
Car
Train
Boat - Direct
Boat - Cruise Ship/Multiple Stops
List below the countries your pet will stop at before the destination country is reached.
What date is your pet leaving the United States? Provide an estimate if not yet certain.
*
-
Month
-
Day
Year
Date
Provide the last air or seaport from where is your pet leaving the United States.
Provide the date YOU arrive in the destination country.
-
Month
-
Day
Year
Date
Provide the date YOUR PET arrives in the destination country.
-
Month
-
Day
Year
Date
Provide the date YOUR PET leaves the destination country.
-
Month
-
Day
Year
Date
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The address in the destination country where your pet will stay during the visit.
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number in the destination country.
-
Country Code
-
Area Code
Phone Number
Will your pet be staying at an additional addresses during their stay?
*
Yes
No
List the additional address in the destination country where your pet will stay during the visit.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number at this address in the destination country.
-
Country Code
-
Area Code
Phone Number
Will your pet be staying at an additional addresses during their stay?
Yes
No
If applicable, list an additional address in the destination country where your pet will stay during the visit.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number at this address in the destination country.
-
Country Code
-
Area Code
Phone Number
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How many pets are traveling?
*
How old will the pet be at the date of travel?
*
Does your pet have a microchip?
*
Please Select
Yes
No
I have more than one pet, but not all of them have microchips
I don't know
What was the date of the microchip implantation?
-
Month
-
Day
Year
Date
Does your destination country require a FAVN Rabies Titer?
*
Please Select
Yes
No
I don't know
Did your airline or cruise ship give you any additional travel requirements for your pet?
*
Please Select
Yes
No
What are the additional requirements?
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Has your pet received a rabies vaccination?
*
Please Select
Yes
No
What is the date of most recent rabies vaccination?
-
Month
-
Day
Year
Date
Please upload your most recent rabies certificate.
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Please upload any additional pertinent documents e.g. vaccine history,previous FAVN results
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