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Health Certificates (Internal Form) - Lange Animal Hospital

Please note that preparing for travel to some countries can take several months. Traveling with a pet in a foreign country can be complex and time-consuming. You need to meet the destination country's specific entry requirements for pets. These may include vaccinations, tests, treatments, and a health certificate. The health certificate may also be called international health certificate, veterinary health certificate, veterinary certificate, or export certificate. Find out what you need before you and your pet travel. https://www.aphis.usda.gov/pet-travel/us-to-another-country-export
Owners Information

First Name

Last Name

Street Address

City

State

Zip Code

Mobile Phone

Home Phone

Work Phone

Email

What date is your pet leaving the United States and from where (last air or seaport in the U.S.)? Must be at least 10 days from date of appt.

List the destination country you are traveling to with your pet.

Who is accompanying your pet while traveling?

Who is accompanying your pet while traveling?
A
B
C
D

How is your pet leaving the United States?

How is your pet leaving the United States?
A
B
C
D
E
F

List all countries your pet will land in/stop at before destination country is reached

Does the Country you are traveling to require Rabies Titer?

Does the Country you are traveling to require Rabies Titer?
A
B

List the address(s) and phone number(s) in the destination country where your pet will stay during the visit.

Does your Pet have a microchip?

Does your Pet have a microchip?
A
B

Microchip Number

Administration Date

Duration

Duration
A
B
C

Administered By

Administered By
A
B
C
D

Who administered your pet’s last rabies vaccination?

Who administered your pet’s last rabies vaccination?
A
B

Other Vaccinations - Indicate which vaccines have been administered, when, and by whom, and when due for boosters.

Deworming - Indicate which product has been administered, when, and by whom.

Provide the date that you and your pet arrive in the destination country?

How many pets are traveling?

How old will the pet be at the date of travel?

Does your destination country require an import permit?

Does your destination country require an import permit?
A
B

Did your airline or cruise ship give you any additional travel requirements for your pet?

Did your airline or cruise ship give you any additional travel requirements for your pet?
A
B