INTERNATIONAL Health Certificate Form Please complete the form at least 72 hours in advance of the appointment. INTERNATIONAL Health Certificate Information Name of Owner Name of Pet(s) -separate by comma List the destination Country you are traveling to with your pet(Required) Who is accompanying your pet while traveling?(Required) The Owner A person authorized by the owner No one A pet transport company is transporting the pet List the address(s) and phone number(s) in the destination country where your pet will stay during the visit:(Required)How is your pet leaving the United States?(Required) Air - Direct Flight Air - Layovers in another country Car Train Boat - Direct Boat - Cruise ship *IF LAYOVERS IN ANOTHER COUNTRY - List the country or countries your pet will land in before the destination country is reached:IF CRUISE SHIP - List all countries the cruise is stopping at:What date is your pet leaving the United States and from where (last air or seaport in the U. S.)?(Required) Provide the date that YOU arrive in the destination country:(Required) Provide the date that YOUR PET arrives in the destination country:(Required) How many pets are traveling?(Required) How old will the pet(s) be at the date of travel?(Required) What type of pet will be traveling?(Required)CHOOSE TYPE OF PETDogCatFerretBird (Other than: chickens, doves, ducks, geese, grouse, guinea fowl, partridges, pea fowl, pheasants, pigeons, quail, swans, and turkeys)RodentHedgehog / tenrecRabbitReptileAmphibianDoes your pet have a microchip?(Required) Yes - You will enter the date implanted next! Yes, but I don't know when it was implanted No I don't know Date Microchip Implanted Who gave your pet’s last rabies vaccination?(Required) The veterinarian issuing my international health certificate administered my pet’s last rabies vaccination A veterinarian other than the veterinarian issuing my international health certificate administered my pet’s last rabies vaccination. I will need to bring the last valid rabies certificate to my appointment I don't know My pet isn’t vaccinated for rabies Date of your pet's last rabies vaccination: Does your destination country require an import permit?(Required) Yes No I don't know Did your airline or cruise ship give you any additional travel requirements for your pet?(Required) Yes, I will give this to the veterinarian issuing my international health certificate No