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Health Certificate Form

"*" indicates required fields

Pet Owner Form for Preparing Visit with Accredited Veterinarian to Complete Health Certificate

Please note that preparing for travel to some countries can take several months.

Complete this form BEFORE meeting with the USDA Accredited Veterinarian who needs this information to complete your international health certificate

List the destination country you are traveling to with your pet*

Who is accompanying your pet while traveling?*

The owner

A person authorized by the owner

No one

A pet transport company is transporting the pet

Address in the destination country where your pet will stay during the visit*

Street Address

Address Line 2

City

State / Province / Region

ZIP / Postal Code

Country

Phone number in the destination country where your pet will stay during their visit*

How is your pet leaving the United States?*

Air – Direct Flight

Air – Layovers in another country. List the country or countries your pet will land in before the destination country is reached

Car

Train

Boat – Direct

Boat – Cruise ship – List all countries the cruise is stopping at

Please specify*

What date is your pet leaving the United States and from where (last air or seaport in the U.S.)?*

Provide the date that you and your pet arrive in the destination country*

How many pets are traveling?*

How old will the pet be at the date of travel?*

What type of pet will be traveling?*

Dog

Cat

Ferret

Bird (Other than: chickens, doves, ducks, geese, grouse, guinea fowl, partridges, pea fowl, pheasants, pigeons, quail, swans, and turkeys)

Rodent

Hedgehog/tenrec

Rabbit

Reptile

Amphibian

Does your pet have a microchip?*

Yes, it was implanted on…

Yes, but I don’t know when it was implanted

I have more than one pet but not all of them have microchips

I don’t know

Microchip was implanted on*

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 country require an import permit?*

Yes

I 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 international health certificate

Signature*

This field is for validation purposes and should be left unchanged.

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1117 W 1st Ave,
Columbus, OH 43212

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Our Hospital
Services
Pet Health
New Clients
- New Client Form
- Payment Options
Contact Us
- Request A Refill
- Emergency
Make An Appointment
Online Pharmacy

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We are open on alternate Saturdays. For more information, Please call us at 614-360-3941.

Health Certificate Form

Pet Owner Form for Preparing Visit with Accredited Veterinarian to Complete Health Certificate

What's Next

Call us or schedule an appointment online.

Meet with a doctor for an initial exam.

Put a plan together for your pet.

Where family pets find loving care