Pet Owner Worksheet 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 worksheet BEFORE meeting with the USDA Accredited Veterinarian who needs this information to complete your international health certificate.

Please fill out this form in addition to sending your pet’s most recent Rabies Certificate to [email protected]

Confirm Home Address *

Address Line 1

Address Line 2

City

State

Zip Code

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

The owner - Name *

A person authorized by the owner - Name *

List the address(s) and phone number(s) in the destination country where your pet will stay during the 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:

Air – Direct Flight. List the country or countries your pet will land in before the destination country is reached *

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

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

If traveling by air, where will the patient be located: *

Cabin
Cargo

*Please be advised sedative medications will not be prescribed to patients traveling in the cargo compartment

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?

You *

Your pet *

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

Does your pet have a microchip? *

Yes, 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

Vaccination Date *

Does your destination country require an import permit? *

Yes
No
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
No

Client Electronic Signature *

Email *

Date *

Health CertificateHealth Certificate Intake Form

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

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