Pet Owner Worksheet for Preparing Visit with Accredited Veterinarian to Complete Health Certificate

Please note that preparing for travel to some countries can take several months. Complete this worksheet BEFORE meeting with the USDA Accredited Veterinarian who needs this information to completeyour international health certificate. Please complete one form per pet if you have multiple pets traveling on the same itinerary.

Owner's Name*

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Pet Name*

Phone*

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

Who is accompanying your pet while traveling?

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

How is your pet leaving the United States?

List the Country or Countries your pet will be stopping at

What date is your pet leaving the United States and from where (last air or seaport in the U.S.)?

Provide the date that you arrive in the destination country?

Provide the date that your pet arrives in the destination country?

How many pets are travelling?

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

What type of pet will be travelling?

Does your pet have a microchip?

Date microchip implanted

When was your pet’s last rabies vaccination?

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

Does your destination country require an import permit?

Yes
No
I don't know

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

Yes, I will give this to the veterinarian issuing my international health certificate.
No

I, the undersigned, do hereby certify that I am over the age of 18 and am the owner (authorized agent) of the above-described pet. I understand this International Health Certificate Checklist must be submitted at least 7 days before the initial International Health Certificate Consultation with our Accredited Veterinarian, and there is no guarantee of your pet's qualifications for issuance of the International Health Certificate

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