Owner Info

Owner Name *

First

Last

Cell Phone *

Email *

Home Address: *

Address Line 1

Address Line 2

City

State

Zip Code

Pet Info

Pet Name *

Age *

Species:

Cat
Dog
Other

Other *

Destination

Destination Address:

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

(City, Reason Address:

Date of Departure:

Location of Departure (City, State):

Method of Travel

Airport
Dock
Car/Truck

Reason for Travel

Vacation
Permanent Relocation
Reentry
Transit

Health Certificate Waiver And Release

It is the pet owner’s responsibility to make sure that their pet meets all the requirements of the destination country before entry. Please use PetTravel to confirm the requirements of each country. If USDA endorsement of the health certificate is required, please schedule your pet’s appointment with us 5-7 days in advance of your departure date to allow adequate time to send the health certificate off.

You must bring all medical records for the patient(s) with you to the exam to avoid additional costs associated with potential vaccination or treatments that may be needed to meet these requirements.

By signing, I acknowledge that I have read, understood, and agree to all the terms listed above and confirm that all the information given on this form is correct.

Printed Name *

Signature of Owner/ Authorized Agent *

Clear Signature

Date *

Health Certificate Form