Health Certificate Questionnaire Form

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Fill Out Our Health Certificate Questionnaire Form

Name *

First

Last

Email *

Who will be traveling with the pet? *

Myself
A designated person who is not myself, who is authorized to travel with my pet

Will you be on the same plane as your pet or will you arrive within 5 days of my pets arrival? *

I will be on the same plane/travel plans
I am not on the same plane as my pet;however, my pet will be arriving within 5 days of my arrival
None of the above apply

What country/state will my pet be traveling to? *

Information of owner or designated travel companion

Legal Name *

Current U.S Address *

Address Line 1

Address Line 2

City

State

Zip Code

U.S phone number *

Address where animal is traveling to *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Phone number where you or designated person are reachable in the country your pet is traveling to *

Is your pet traveling in cabin or cargo? *

cabin
cargo

Airline Carrier *

When are you leaving *

Information regarding your pet

Pets Name *

Breed *

Color *

Sex, is your pet altered? *

Date of last heartworm, flea, tick prevention *

I agree to provide all requested medical records for my pet as required for my veterinarian to complete a health certificate. This includes all rabies vaccine history/certificates

Phone

Health Certificate Questionnaire Form

Fill Out Our Health Certificate Questionnaire Form

Information of owner or designated travel companion

Information regarding your pet

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Location

Contact Information

Hours

Emergencies

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