Health Certificate Request Form
All horses will need to have a current negative Coggins on file and have been recently inspected by one of our veterinarians to comply with state and federal regulations. Please request an appointment if either or both are needed.
Date Leaving
*
-
Month
-
Day
Year
Date
Owner of horse
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Are horses currently stabled at home address?
*
Yes
No
Current Horse Location ( Include address if not at owner's home address)
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Address
Street Address
Street Address Line 2
City
State
Zip Code
Is Consignee (Person receiving or accompanying horse to destination) the owner?
*
Yes
No
Consignee (Person receiving or accompanying horse to destination)
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Destination (or name of property owner)
*
Phone Number
*
Format: (000) 000-0000.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Is the horse owner hauling?
*
Yes
No
Person or Company hauling horse
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Current Coggins?
*
Yes, drawn by and on file with Weitz Equine
Yes, drawn by another vet (upload a copy)
No, I need to make an appointment
If Coggins was drawn by another vet, please submit a copy
Browse Files
Drag and drop files here
Choose a file
Cancel
of
List of horses to include on certificate
*
Reason for Travel
Pleasure
Show
Sale
Moving
Other
Submit
Should be Empty: