HEALTH CERTIFICATE INTAKE FORM

HEALTH CERTIFICATE INTAKE FORM
Thank you for trusting Night Watch Elite Animal Emergency with your pet travel needs. Our skilled and experienced veterinarians are USDA-accredited for domestic and international pet travel. Please carefully read and and fill out the important information below. The information provided within the health certificate intake form below will be entered into your pet's official health certificate and submitted to the U.S. Department of Agriculture. Please take the time to ensure that the information is complete and accurate. Please be sure to provide all the information asked, as this will minimize the back and forth needed in order to complete your pet's health certificate. Night Watch Elite Animal Emergency is not liable for incurred fees and/or declined entry into destinations due to errors within the health certificate intake form. Please note that completion of this form does not secure your appointment booking. After pressing "submit", your form will be sent to our Pet Travel Specialist. Once recieved, you will be contacted by our Pet Travel Specialist to discuss any additional items needed and/or booking your appointment. For all international destinations, we require a minimum of 30 days notice prior to travel. All international health certificate appointments are subject to approval by our Pet Travel Specialist before booking. Note: If you require urgent assistance for immediate travel in 30 days or less, please complete the form below and call us at (210) 455 - 4559. Please note that your travel request may not be accomadated due to timeline restrictions (either due to restrictions imposed by the entering state or country or due to scheduling and appointment availability), and depending on your pets medical records. Please check the box indicating you accept the above requirements. Thank you, and we look forward to serving your pet travel needs.
Please check the box indicating that you have read, understood, and consent to the above statement*
In no event shall Night Watch Elite Animal Emergency be liable for financial loss(es) incurred as a result of pet travel, including but not limited to: Errors in Health Certificate Information, travel delays, flight re-booking/cancellations, quarantine fees, hotel/accomadation costs, etc. Please note: Pet Travel Services with Night Watch Elite Animal Emergency include exporation from the US only. Night Watch Elite Animal Emergency does not assist with the importation or return of pets to the US. Requirements for returning to the US are affected by the length of time outside the country, layovers, and other specefics related to your destination country. Returning to the US is the responsibility of the pet owner. For guidance on returning to the US, please contact the USDA, CDC, or a local veterinarian at your destination for assistance. Lengths of travel, stay, layovers, and destination may vary with requirements for return.
Please check the box indicating that you have read, understood, and consent to the above statement*
Owner Information
Legal Name of Traveler (Should match boarding ticket information)*

First NameMiddle NameLast Name
If traveler is not the legal owner of pet, please list the relationship here
Traveler Email*
example@example.com
Traveler Phone Number*
Please enter a valid phone number.
Address (WHERE PET IS ORIGINATING FROM)*

Street Address

Street Address Line 2

CityState

Zip Code
Address (DESTINATION OF PET)*

Street Address

Street Address Line 2

CityState/Province

Postal/Zip CodeCountry
Phone Number AT YOUR DESTINATION*
Please enter a valid phone number.
Date of Travel (Leaving Texas)*

MonthDayYear
Date
Date of Arrival to Destination*

MonthDayYear
Date
Travel/Flight Information
Method of Travel*

AirplaneCar/BusBoatTrainOther
Airline (If flying)*
Do you have a layover?*
Your Pet is Traveling in: *
Note: Sedative medications will not be prescribed to animals traveling in the cargo compartment
City/State/Country AND Airport of Arrival*
If arrival airport is not your final destination (i.e. driving to another city from the airport), please list the city/state/country of final destination below:*
Purpose of Animal Movement (please choose one):*

Pleasure/VacationRelocation (Permanent Import)Rescue/Shelter/Transfer of animal for sale or adoptionOther
Are you planning to re-enter the US with your pet?*
Pet Information (If multiple pets, please fill out separate intake forms for each animal)
Pet Name*
Species*
Gender*
Breed*
Color*
Age/DOB*
Microchip Manufacturer*
Microchip #*
Date of Microchip Placement*

MonthDayYear
Date
Does your pet have a pet passport?*
Date of TWO most recent Rabies Vaccines [Rabies Certificates must be emailed to nightwatchclients@gmail.com and MUST include Rabies vaccine information (Manufacturer, Lot/Serial Number, Expiration Date of Vaccine, Vaccination duration expiration, administering clinic and signature of veterinarian, and microchip number of pet)]
Date 1:    Date*
Name & Manufacturer of Vaccine:*
Date 2:   Date*
Name & Manufacturer of Vaccine:*

Please email BOTH rabies certificates, vaccination records, and recent testing to: nightwatchclients@gmail.com
*Please note that if your pet is not up to date with their rabies vaccines and/or does not meet travel requirements to your desired destination, you may be advised to postpone your travel date.
Client Signature*

Clear
Printed Name*

First NameLast Name
Date*

MonthDayYear
Date
Should be Empty:

HEALTH CERTIFICATE INTAKE FORM

Owner Information

Travel/Flight Information

Pet Information (If multiple pets, please fill out separate intake forms for each animal)