Health Certificate Form Owner's Name * First Name Last Name Primary Phone Number * (###) ### #### Email * Current Address * Address 1 Address 2 City State/Province Zip/Postal Code Country How are you traveling with your pet? * Car Airplane Ship Other If traveling by airplane, how will your pet be accompanying you? In Cabin In Cargo Please list which airline your pet will be traveling with if applicable Where are you traveling with your pet? * Domestically, within the continental U.S. Alaska or Hawaii Internationally Address Traveling To * Address 1 Address 2 City State/Province Zip/Postal Code Country Does the travel destination have a different point of contact? * Yes, I will provide their information below No, I am traveling with my pet and staying with my pet Please provide secondary point of contact below if applicable Pet's Name * Species * Canine Feline Description * Breed, Colors, Distinctive Markings Date of Birth * If you are not sure, please estimate. MM DD YYYY Sex Male Intact Male Neutered Female Intact Female Spayed Is your pet microchipped? * Yes No I'm Not Sure Does your pet require any testing prior to entry? Yes No Please provide the microchip number and the date the microchip was administered if you answered yes above.. Please list any other important travel and/or health certificate information that you have regarding your pet Would you like your pet to have any heartworm/flea & tick prevention before traveling? * Yes No Thank you!
