International Health Certificate Checklist International Health Certificate Checklist 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 complete your international health certificate. Name * Name First First Last Last Pet's Name * Address * Address Address Address City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal Phone * Email * 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? Air – Direct Flight Air – Layovers in another country. Car Train Boat – Direct Boat – Cruise ship List the country or countries your pet will land in before the destination country is reached 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.)? 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? Radio Buttons Dog Cat Ferret Rodent Hedgehog/tenrec Rabbit Reptile Amphibian Bird (other than: chickens, doves, ducks, geese, grouse, guinea fowl, partridges, pea fowl, pheasants, pigeons, quail, swans, and turkeys) Does your pet have a microchip? Yes Yes, but I don’t know when it was implanted. I have more than one pet but not all of them have microchips. No I don't know Implanted on 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 of Vaccination 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 Signature of owner or owner representative * signature keyboard Clear Date * Captcha Submit If you are human, leave this field blank.
