Domestic and International Health Certificate Questionaire

Domestic and International Health Certificate Questionaire
Please note that preparation for traveling with your pet(s) to some countries can take months of planning. If you are traveling to New Zealand, Japan, or Hawaii, please consult with a pet transport company to make sure you have everything you need.

*This form must be returned no later than 24 hours before your scheduled appointment.*
Client Information
Client Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Patient Information
Patient Name*
Species*
Breed*
Sex*
Age*
Weight*
What is the address of your destination country/state where you and your pet(s) will be staying? *
When is your departure date? *

MonthDayYear
Date
*Please note that most Health Certificates need to be issued within 10 days of travel.
When are you and your pet(s) arriving at your destination country?*

MonthDayYear
Date
What species is your pet? How many pets will be traveling with you?*
Who will be travelling with your pet(s)*
When was your pet(s)' last Rabies vaccine? Please provide the Rabies Certificate with this form. *
*NOTE: you need to provide proof of vaccinations to complete the Health Certificate. You must provide a physical copy of your Rabies Certificate (for any Rabies vaccines given previously) as is required by the USDA at the time of health certificate endorsement.
What is the name of your previous veterinarian (if applicable)?*
Please consult the APHIS website for the following information
What type of health certificate will be required ?*

A country-specific health certificateA generic health certificateA Certificate of Veterinary Inspection
What vaccines does your destination require?*
When must the vaccine be given?*
Is your pet required to be microchipped?*

YesNo
If so, what is the microchip number and manufacturer?*
Is your pet registered as any of the following ?*

Service animalEmotional support animalTherapy animal
Are there any laboratory tests required by your destination county/state?*

YesNo
If yes, what tests are required and when must those samples be collected?*
*NOTE: required samples MUST be collected within the testing time frame required by your destination country/state. Some test may take a long time for results, and/or some countries require a waiting period after testing and before entry.

Please also check with your airline(s) to determine any requirements they may have in addition to those required by our destination. Airlines have additional forms to complete for service animals and/or pet(s) traveling in the cargo hold. If you intend to bring your pet(s) back into the U.S., there may be additional re-entry requirements.

For international travel, you will need to contact the USDA APHIS Veterinary Services office for an endorsement appointment. Some offices offer to review Health Certificates before submission. Please work with your endorsing USDA office to determine the best options for paperwork review and/or submission.
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Domestic and International Health Certificate Questionaire

Client Information

Patient Information