Health Certificate Form in Tulsa, Oklahoma - Woodland West Animal Hospital

Appointment Date at Woodland West Animal Hospital

Date of Exam Appointment to obtain Health Certificate

Name of Consignor or Rescue Group (Person or Rescue Group Transporting Pet)*

If pet is under a Rescue Group List Name of Rescue Group Transporting Pet If Not Applicable Type N/A

If Not Applicable Type N/A

Address of Owner or Rescue Group*

Street Address Address Line 2 City State ZIP Code

Phone Number of Cosignor*

Email Address Of Person Transporting

Email Address Of Rescue Group Leaving from If Applicable N/A if not Applicable

Enter Email Confirm Email

N/A if not Applicable

Consignee (Person Receiving Pet)*

First Last

If A Rescue Group is Consignee Please List Name of Rescue Group

Address Of Where Pet Will Be Arriving*

Street Address Address Line 2 City State ZIP Code

Phone Number of Consignee or Rescue Group Receiving Pet*

Email Address Of Consignee*

Enter Email Confirm Email

Email Address Of Rescue Group Arriving To If Applicable If Not Applicable Type N/A

Enter Email Confirm Email

N/A if not Applicable

Date The Pet will be Traveling*

Pet Name*

First

Breed*

Sex*

Female
Male
Spayed Female
Neuter Male

Birthdate*

Description, Color, And Unusual Markings

Does The Pet Have A Microchip*

Yes
No

Microchip Number

Rabies Vaccine Previously Given? *If the Rabies vaccine was given at another Veterinary Clinic please attach the Vaccine records when submitting this form*

Yes
No

Rabies Tag Number And Date If Already Given

Do We Need To Give Any Vaccines At Time Of Exam Required for Health Certificate?*

Yes
No

Any Pertinent Information

*Please Submit Previous Vaccine Records If Applicable*

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