Tequesta Veterinary Clinic - International and Domestic Travel Certificate Form

Travel Certificate Information

Please note that preparing for travel to some countries can take several months.
Complete this worksheet BEFORE your appointment. Our veterinarian needs the information in this document to complete your health certificate.
Client Name*

First NameLast Name
Client's Current Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Client Phone Number*
Please enter a valid phone number.
Client Email Address*
example@example.com
Pet's Name*
Pet's Sex*

MaleFemale
List the destination you are traveling to with your pet:*
Who is accompanying your pet while traveling?*

The ownerA person authorized by the ownerA pet transport company is transporting the petNo one
List the address(s) and phone number(s) of the destination address (as it would appear as a mailing address) where your pet will stay during the visit.*
How is your pet traveling?*

Air - Direct FlightAir - Layovers in another countryBoat - DirectBoat - Cruise ShipVehicle
List the states, country, or countries your pet will land in before the destination location is reached (if applicable):
List all countries the cruise is stopping at (if applicable):
What date is your pet leaving the United States and from where (last air or seaport in the U.S.)? - if applicable:
Provide the date that you and your pet arrive at your destination? Your arrival date? Your pet's arrival date?*
How many pets are traveling?*
How old will your pet be at the date of travel?*
What type of pet will be traveling?*

DogCat
Does your pet have a microchip?*

YesYes, but I don't know when it was implanted.I have more than one pet but not all of them have microchips.NoI don't know
When was the microchipped implanted?
When was your pet's last rabies vaccination?*

The veterinarian issuing my international health certificate administered my pet’s last rabies vaccination.A veterinarian other than the veterinarian issuing my international health certificate administered my pet’s last rabies vaccination. I will need to bring the last valid rabies certificate to my appointment.I don't know.My pet isn't vaccinated for rabies.
Does your destination require an import permit?*

YesNoI don't know
Did your airline or cruise ship give you any additional travel requirements for your pet?

Yes, I will give this to the veterinarian issuing my health certificate.No
Please include past travel certificates, FAVN results, Pet Passports, etc, for the above-mentioned pet.
Please upload any files that may assist us in completing your pet's health certificate.

Cancelof
It is the responsibility of the owner to ensure all appropriate documents, medications, vaccines and forms are completed, accurate and on time. Tequesta Veterinary Clinic does its best to guide owners on international and domestic health certificates, but does not take responsibility of any missed deadlines or costs incurred from this process.

Depending on your type of travel, it is our recommendation that every owner involve the help of a pet transportation service to prevent any potential issues. If the owner choses to move forward with this process without a pet transportation service, they understand that they are doing so at there own risk.

Please review the USDA website for information on health certificates and requirements.

I hereby declare that I understand the above information. I understand that it is my sole responsibility to review all USDA requirements and ensure all requirements are filled, information is accurate and appropriate time is given.

I understand that if have chosen to proceed without a pet transport company no refund will be given regardless of the reason.
Signature*

Clear
Today's Date*

MonthDayYear
Date
Should be Empty:

Travel Certificate Information