3734 S Moody Ave. Portland, Oregon 503-477-4757
wildwoodhealthcertificates@gmail.com
International Travel Questionnaire
These answers will help us create your pet's international health certificate. Please note - we are NOT a travel company, but we can guide you to obtain the correct documentation you need to travel with your pet! We highly suggest you look up your country's requirements before scheduling an appointment by going to https://www.aphis.usda.gov/pet-travel
List the destination country you are traveling to with your pet
*
What type of import is this?
*
Permenant
Temporary
Is the animal traveling a service animal?
Yes
No
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Are you a new client?
Yes
No
List the name of your previous veterinary clinic(s) (if other than Wildwood Veterinary Clinic) so we can obtain your pet's records:
Previous Veterinarian's phone number:
Please enter a valid phone number.
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Who is accompanying your pet while traveling?
*
Me (the owner)
A person authorized by the owner
A pet transport company is transporting the pet
No one (pet traveling alone)
Owner's Name
*
First Name
Last Name
Owner's Email
*
example@example.com
Owner's Phone Number
*
Please enter a valid phone number.
Owner's International Phone Number (if applicable)
Please enter a valid phone number.
Person Authorized by the owner
First Name
Last Name
Person Authorized Phone Number
Please enter a valid phone number.
Pet Transport Company Name
Pet Transport Company Email
example@example.com
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Please list your CURRENT address In United States (or where you've been staying) Must be an Oregon address!
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Please list the address of your destination (if known)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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How is your pet leaving the United States?
Air - Direct flight (no layovers)
Air - Layover if another state/country. Please list the state, country or countries your pet will land in before the destination is reached:
Car
Train
Boat - Direct
Boat - Cruise ship - please list all countries the cruise is stopping at
List place(s) of layovers in order of arrival
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What date is your pet LEAVING the united states?
-
Month
-
Day
Year
Date
What date is your pet ARRIVING in the destination country?
-
Month
-
Day
Year
Date
What day would you like to schedule your visit?
-
Month
-
Day
Year
*Most appointments need to be scheduled within 10 days of traveling. **We do not schedule international health certificates on Saturdays! (USDA is closed on weekends). ***This does NOT confirm your appointment date/time until our specialist speaks directly with you.
Appointment time preference
Minutes
AM
PM
AM/PM Option
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What airline(s) will you be using?
How is your pet flying?
Cabin
Cargo
Did your airline give you any additional travel requirements for your pet?
Yes, I will give this to my Veterinarian
No
I don't know
Where is your pet traveling from (last air or seaport in the United States)?
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How many pets will be traveling?
*
1
2
More than 2
What type of pet will be traveling
Dog(s)
Cat(s)
Dog + cat
First Pet's Name
*
Second Pet's Name
First Pet's birthday
-
Month
-
Day
Year
Date
Second Pet's birthday
-
Month
-
Day
Year
Date
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Does your pet have a microchip?
Please Select
Yes
No
I don't know
If yes, what date was it implanted?
-
Month
-
Day
Year
Date
Microchip Number
An iso-compliant microchip is typically 15 digits long
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When was my pet's last Rabies vaccine?
-
Month
-
Day
Year
Date
Was it a 1 year or 3 year rabies vaccine?
1 year
3 year
I don't know
Please attach a SIGNED rabies certificate if applicable
Browse Files
Drag and drop files here
Choose a file
Cancel
of
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Does your destination country require an import permit?
Yes
No
I don't know
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If the official certificate has to be shipped back from the USDA, would you prefer it be shipped to you or to the clinic? (This will be shipped using a FedEx overnight label provided by us)
My home
To the clinic
If you choose your home, please list name and address of where it should be sent
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Would you like to discuss sedatives for your pet for the flight?
Yes
No
Is your pet on any flea/tick preventatives?
Please Select
Yes
No
This is required by some countries
If yes, which one?
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Is there anything else you'd like to discuss with the Veterinarian?
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Signature
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