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Health Certificate for Travel Request Form

"*" indicates required fields

In preparation of your International Health Certificate travel, we will need the following information

Client's First Name*

Client's Last Name*

Patient's Name(s)*

Travel Location*

Date Leaving for Travel*

Destination Arrival Date*

Address of Travel Residence*

Street Address

Address Line 2

City

State / Province / Region

ZIP / Postal Code

Country

Is there a connecting flight?*

Yes

No

If yes, what country?*

Is your pet microchipped?*

Yes

No

Do you have records for your pet(s) at another hospital?*

Yes

No

Depending on your destination, your pet’s microchip needs to be implanted before or on the date of the Rabies vaccination. This will determine whether or not we are able to complete this form for you

If yes, please let us know which hospital so we can call for records*

Name

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