Pet Travel Health Certificate

Health Certificate Pre-Application for Foreign and Domestic Travel for a Pet

Thank you for allowing us to assist you with the process of obtaining a travel health certificate for your pet. Please review the following information carefully and initial each point to indicate you understand and agree to the information. Submission of the pre-application with your 50% deposit on the health certificate fee is required to reserve your health certification appointment.


Please read and check all.

Date of Application*:

Name*:

The following information will help us get a head start on preparing the health certificate and save you processing time. Please be sure your personal information matches your identification documents.


ORIGIN/CONSIGNOR CONTACT INFORMATION
*The Consignor is typically the pet owner.*

Consignor Name:

Consignor Address:

Consignor Phone:

Consignor Email:

DESTINATION/CONSIGNEE CONTACT INFORMATION
*The Consignee is also typically the pet owner, but if the pet will be sold to or adopted by another party, that person would be the Consignee.*

Consignee Name:

Consignee Address:

Consignee Phone:

Consignee Email:


Will the pet be traveling with the owner? If no, please provide Guardian Contact Info.

GUARDIAN INFORMATION
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Guardian Name:

Guardian Address:

Guardian Phone:

Guardian Email:

TRAVEL INFORMATION

Port of Embarkation:

Destination State or Country:

Date of Travel:

Airline & Flight #:

Temporary or Permanent Relocation (Required Field):

Date of Return:

PET INFORMATION

Pet Name:

Species (Dog, Cat):

Breed:

Gender:

Microchip #:

Age:

Medical Records:

If your pet has medical records from another veterinary hospital, please arrange to have them emailed or faxed at least 2 days prior to your appointment, including rabies and vaccination certificates.

Email: info@ervethosp.com
Fax: (678) 922-7312

Thank you! We will contact you within the next business day to schedule your appointment and make arrangements for the deposit payment.

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