Please write N/A if not applicable or unknown.

For most destinations, we require at least 30 days advanced notice of travel. Some destinations require almost a years worth of tests and requirements, please be understanding if we cannot accommodate your initial travel date. Should you need to travel immediately, please contact our clinic, 858-270-4120, and fill this form out so we may try and assist your urgent travel needs. *

Please check this box stating you have read the above statement and understand the importance of inputting the correct information.

Owner Information

Legal Name of Traveler *

First

Last

Traveler Email *

Address in the United States *

Address Line 1

Address Line 2

City

State

Zip Code

Phone Number in the United States *

Address at your destination *

Phone Number at your destination (if in another country please put the # that works): *

Date of Travel (Date leaving the United States) *

Date of arrival to destination *

Travel/Flight Information

Method of travel *

Airplane
Car
Boat
Train

Flight Information (Airline Name, Flight #) *

City/State/Country you are flying out of *

Do you have a layover? *

Yes
No

If yes, please list the layover City/Country and Duration of Layover:

If your pet traveling in Cabin or Cargo?

Cabin
Cargo (*Sedative medications will not be prescribed to patients traveling in the cargo compartment)

Purpose of Animal Movement *

Pleasure (Traveling for Fun)
Relocation (Permanent Import)

Pet(s) Information (if multiple please fill out separate intake forms)

Species *

Feline
Canine

Pet Name *

Sex of Pet: *

Male, Intact
Male, Neutered
Female, Intact
Female, Spayed

Pets DOB *

Breed/Color *

Microchip # (if known):

*your pet will be scanned for a microchip during today's visit

Date of placement of Microchip

*Microchip must be implanted prior to the first Rabies Vaccination

Does your pet have a pet passport? *This may alter your pets required paperwork* *

Yes
No

Dates of most TWO most recent Rabies Vaccinations: *

*If your pet did not receive a Rabies Vaccination from our facility, we need you to email the original copy(s) of the rabies vaccination certificate. The Rabies Certificate must include; your pets microchip #, administering veterinarians signature and all of the rabies vaccine information (lot #, manufacturer, vaccine name, vial expiration). Please email to [email protected].

Date of Vaccination #1 *

Name and Manufacturer of Rabies Vaccination #1 *

Date of Vaccination #2 *

Name and Manufacturer of Rabies Vaccination #2 *

We suggest you do your own research as well, here is a website you can input your information to that will help provide you with some guidance before we reach out to you for the Health Certificate Consultation. Website link here.

Upload l Records/Vaccination/Testing Documents

Click or drag files to this area to upload. You can upload up to 10 files.

Client Electronic Signature *

Date *

Health CertificateHealth Certificate Intake Form

Owner Information

Travel/Flight Information

Pet(s) Information (if multiple please fill out separate intake forms)

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