Health Certificate Form

Pet's name:      Species:   Cat   Dog     
Breed:      DOB/Age:      
Sex:   Female   Female Spayed   Male   Male Neutered       
Is your pet microchipped?   Yes   No         
If yes, what is the microchip number?   Type a label   

Travel Destination:      

Will you have any layovers or destinations in multiple countries?   Yes   No  
If yes, which countries?      

Departure Date:   Date   

Where will you be flying out of?      

Arrival Date:   Date   

Address in Destination Country:   Street Address   Address Line 2   City   State   Zip   

Phone Number in Destination Country:   Area Code   Phone Number   

Will your pet be coming back to the U.S.?   Yes   No      

How will your pet be flying?   Cabin   Cargo      

Is this pet intended for resale?   Yes   No