International 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? * 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 Which country are you traveling with your pet? * 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 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 Does your pet require any testing prior to entry? * Yes No Would you like your pet to have any heartworm/flea & tick prevention before traveling? * Yes No Where has your pet been seen for vaccinations? * High Country Veterinary Hospital Another veterinary facility My pet has never recieved any vaccinations Thank you!
