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Home International Health Certificate Form

International Health Certificate Form

Health Certificate Information — Owner To Complete

Please make sure to visit the USDA website https://www.aphis.usda.gov/pet-travel as well as the airline website for all protocols

DEPARTURE DATE:(Required)

MM slash DD slash YYYY

Are you a current client?(Required)

Yes

No

Name of The Veterinary Hospital Your Pet Was Last Seen By(Required)

Pet's Name:(Required)

Pet Type(Required)

Cat

Dog

Breed(Required)

Pet’s Birth Date

Sex(Required)

Male

Female

Color of Pet(Required)

Is Your Pet Spayed/ Neutered?(Required)

Yes

No

Date of Pet’s Last Rabies Vaccination

Does Your Pet Have a Microchip(Required)

Yes

No

What is your pet's microchip number?

Owner’s Origination (Local) Address

Name of Owner Traveling with Pet(Required)

Address(Required)

City(Required)

State(Required)

Zip Code(Required)

Country(Required)

Phone Number(Required)

Email Address(Required)

Owner’s Destination Address

Owner's Name (if different from person travelling with pet)

Address(Required)

City(Required)

State(Required)

Zip Code(Required)

Country(Required)

Phone Number(Required)

Email Address(Required)

Purpose of Movement

Travel/Temporary Visit

Relocation/Moving

Sale

Exhibition

Other

Movement Other Details

Method of Travel

Airline

Car/Truck

Boat

Other

Other Travel Details

Airline/Flight Information

Airline:

Flight Information:

Is This a Direct Flight?

Yes

No

Click to Attach Medical Records/Vaccine History/Other Document

Max. file size: 10 MB.

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540-370-0237

756 Warrenton Rd,
Fredericksburg, VA 22406

Make An Appointment

540-370-0237

756 Warrenton Rd,
Fredericksburg, VA 22406

Make An Appointment

Online Pharmacy Pet Portal

Home
Our Veterinary Hospital
Services
Client Resources
Online Pharmacy
Contact Us

Business Hours

Monday

8:00am - 6:00pm

Tuesday

8:00am - 6:00pm

Wednesday

8:00am - 6:00pm

Thursday

8:00am - 6:00pm

Friday

8:00am - 6:00pm

Saturday

Closed

Sunday

Closed

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