International Health Certificate Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pet(s) before your visit.

This form MUST be filled out 24 hours PRIOR to your appointment date/time. To ensure the USDA has sufficient time to endorse your certificate, appointments must be made 10 days prior to your departure date (ie., if your date of travel is on the 15th of the month, you must make your appointment on the 5th of the month). USDA's turnaround time is currently 8-10 days to return an endorsed certificate. We kindly ask that you make your travel arrangements accordingly.

Destination Country

Type of Admission

Permanent Import (pet will not return to US)

Re-entry (pet is returning to country of origin)

Temporary Admission (pet is traveling for leisure)

Pet Owner

First Name

Last Name

Owner Address

Owner Phone Number

Person Traveling with Pet

First Name

Last Name

Destination Address

Destination Phone Number

Mode of Transportation

Port of Departure

Port of Entry

Date of Travel

Commodity Type

Dog (Canine)

Cat (Feline)

Pet Name

Pet Breed

Pet Sex

Male

Female

Neutered Male

Spayed Female

Pet Age

List the previous Veterinary Hospitals where your patient received care and vaccines

Is your Pet up to date with all vaccinations?

Yes

Unsure

Is your Pet Microchipped?

Yes

Unsure

If yes, please write your pet's Microchip number

Acknowledgment

You certify that the information you provided on this form is accurate. Any mistakes can delay a fully endorsed certificate and you may miss your mode of travel. Additionally, each country has separate requirements for entry. You understand that whatever requirements that need to be satisfied will be at an additional cost.