Information Request for Travel Documents / Health Certificate

Your Name:

First NameLast Name

What Country, State, or US territory is your pet traveling to? (If traveling to Hawaii or another Non-continental U.S. Territory please complete the international travel questions as well)

Purpose of Travel:

Date of departure:

Date

Date of arrival at destination:

Date

The physical address your pet(s) are leaving from (No PO Boxes)

Street Address

Street Address Line 2

CityState

Zip Code

Email

example@example.com

Phone Number while traveling

Country CodeArea CodePhone Number

Who is accompanying your pet while traveling?

To be completed only if the animal is traveling with anyone other than it's legal owner. Please list the name, phone number and email address for the person/company your pet will be traveling with:

How will your pet be traveling?

If traveling by Plane, will your pet be flying in the Cabin or in Cargo?:

(International travel only) If traveling by plane or boat with stops or layovers in other countries, please list all countries you will stop in before desination country is reached:

Please list the airline, cruiseline, or railline your pet will be traveling on:

Name of person the pet is going to at destination country (list yourself if your pet is remaining with you)

First NameLast Name

Physical address where your pet will be staying in your destinatin country (No PO Boxes)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number for person at destination:

Country CodeArea CodePhone Number

Does your destination require an import permit?

Does your airline or cruise ship give you any additional travel requirements for your pet?

(International travel only) If traveling to another country, will you be returning to the USA?

(International travel only) If yes, provide and estimated date of return?

Date

How many Pets are you traveling with?

Please list the name(s), Microchip Number(s), Microchip implant date(s), date of birth, species (Cat or dog), and breed for each pet you will be traveling with. **Please note we are unable to assist with Large Animal travel requirements at this time.**

Does your pet/any of your pets have a second microchip?

If yes, please list the pets name and their additional micochip number(s)

If your pet sees another Veterinary Clinic/Hospital please list their name, phone number and email address: (Write none if your pet is not seen elsewhere)

If you have a copy of your pet's records from another veterinary hospital/clinic, or vaccine clinic please upload them here:

(International travel only) Does your pet have an EU Passport? (if yes, please upload photos in the file drop above, text clear photos to 207-288-5733, or email the photos to acadiavh@yourvetdoc.com)

Any additional notes, comments, or questions:

To schedule my appointment, I prefer to be contacted by:

I hereby acknowledge that while, Acadia Veterinary Hospital may assist with understanding the requirements needed for my pet to travel to my selected destination, it is ultimately my responsibility to ensure that my pet meets all requirements. Information about my destination's requirements can be found at: https://www.aphis.usda.gov/pet-travel