International Health Certificate Form

Please complete this worksheet PRIOR to scheduling your appointment for an international health certificate with us, as it will expedite the process. Once this form and the required documention is received, one of our staff members will reach out to schedule an appointment. Improper or incomplete paperwork for your pet can derail your travel plans, costing you time and money.

Please email (info@highlandsranchanimalhospital.com) Rabies Certificates (signed in blue ink - please inform us if you need an updated Rabies Certificate), as well as any previous vaccination records. Visit https://www.aphis.usda.gov/aphis/pet-travel for information on pet travel to your destination country.

PLEASE READ, PRINT, and SIGN that you understand the following:

Many countries have their own pet health certificates and travel requirements, available at https://www.aphis.usda.gov/aphis/pet-travel

The international Health Certificates must be issued by one of our USDA accredited veterinarians as near to the travel date as possible, but no more than 21 days before travel. The Certficate should indicate the following:

Name of Pet

Breed Color

Pet's Birthdate

Country of Origin

Destination of Travel (Address)

Name/Address/Phone Number of the Pet Owner

Confirmation that Pet is healthy and free of Parasites

Vaccinations given, includng type, manufacturer, and batch number

Microchip # (if applicable)

Generally, the rabies vaccination must be given at least 30 days, but no more than 12 months, prior to travel, although some countries may have different requirements. However, you must enter your destination country before your pet's most recent rabies vaccination has expired. Some countries may also require a rabies titer (for export) to be done a specific time frame in advance.

Along with an international health certificate, there may be additional requirements for traveling abroad. Please take some time to familiarize yourself with the international pet travel requirements specific to your destination country prior to your appointment (THIS IS NOT OUR RESPONSIBILITY).

Improper or incomple paperwork for you pet can derail your travel plans, costing you valuable time and money. If you have any questions our staff is happy to help.

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

Date

Signature

How Many Pet's Are Traveling?*

If More Than One Pet - a form will be required for each individual animal traveling

What Species is Your Pet?*

Cat or Dog

What Breed is Your Pet?*

Pet's Name*

Name must match Rabies Certificates

MaleFemaleSpayedNeutered

Pet's Birth Date*

MonthDayYear

YesNoUnsure

If yes, when was the microchip implanted? *

If unknown, use the date your pets last Rabies vaccine was given.

Microchip Number*

Please Put N/A if Unknown

When Were Your Pet's Last Two (2) Rabies Vaccinations? (NOTE: Provide Original Rabies Certificates Signed in BLUE ink.)*

Please put N/A if unknown

YesNoUnsure

What Practice Were Your Pet's Previous Vaccinations Given? List Clinic and Contact Information - if given at HRAH, please write down our hospital.*

Last Dose of Preventative Given and Brand:*

Please put N/A if unknown

YesNoUnsure

Name of Owner Traveling with Pet*

First NameLast Name

List The Destination Country to Which You Are Traveling With Your Pet:*

What Date Is Your Pet Leaving The United States:*

Date

What Date Is Your Pet Arriving in the Destination Country:*

Date

What Date are YOU (THE PET OWNER) Arriving in the Destination Country:*

Date

Address of Location Pet Is LEAVING (Pet's Home Address) From in THE UNITED STATES:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

YesNo - Please enter delivery address in the note section at the bottom of this form.

Phone Number where Pet is LEAVING in United States:*

Format: (000) 000-0000.

Address of Location Pet Is ARRIVING (Where Pet is Staying) to in DESTINATION COUNTRY:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number Where Pet Is ARRIVING in DESTINATION COUNTRY:*

Format: (000) 000-0000.

What Airline is Your Pet Traveling On?*

What City and Airport is Your Pet Leaving From?*

CargoCabinPet Transportation Hauler

DirectLayoverOther

If the Flight has a layover, what country is the layover?

TemporaryPermanent

Owner Information

Owner's Name*

First NameLast Name

E-mail*

example@example.com

Phone Number*

Format: (000) 000-0000.

Secondary Number

Format: (000) 000-0000.

Today's Date:*

Date

Please Describe Anything Else We May Need to Know About Your Trip. Are there any other countries being visited? If so please list address and information below. Another form may need to be filled out.

International Health Certificate Information and Authorization Form

Pet Information

Vaccination Information - PET

Travel Information - PET