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Health Certificate Form

If your pet has received medical care from anywhere else besides Animal Clinic of Grand Prairie please email your pet's previous health records to: acgpvets@gmail.com

Please read the information below carefully so you are aware of any necessary requirements for you and your pet to complete prior to travel. Because our veterinarian is licensed and accredited in the State of Texas, only pets whose travel is originating in the State of Texas may be issued a Health Certificate.

When travelling with your pet(s), there may be animal health requirements specific for that destination. As soon as you know your travel details, contact your local veterinarian to assist with the pet travel process. Factors to consider may include meeting time frames for obtaining a health certificate, updating vaccinations, diagnostic testing, or administration of medications/ treatments.

Your destination state or country may have specific health requirements that must be met before your pet can enter the state or country. Since export requirements are determined by each state or country and can change frequently, every time you plan pet travel you will need to verify the export requirements. Some countries and states (such as Hawaii, Japan, Australia, Turkey, United Arab Emirates, etc.) require a rabies titer (FAVN) test and a waiting period after the FAVN is submitted before the pet may be imported to that state or country. The FAVN test takes from 3 to 8 weeks or more for results to return, please ensure you take this time frame into account when planning your travel. Please also note that airlines may have separate and additional requirements. Check with your airline to determine what requirements they may have, if any.

To learn the requirements for moving your pet from your current location to another U.S. state or foreign country, please review the links listed below. If you have additional questions or need to determine what type of form will be accepted when the pet travels, please contact the State Veterinarian’s office in the destination state or the United States Department of Agriculture.

USDA - Taking Your Pet to a Foreign Country (International Travel)

USDA - Taking Your Pet State to State (Interstate/Domestic Travel)

Hawaii - Animal Quarantine Information Page

Hawaii - Checklist 1 for pets flying into Honolulu Airport (HNL)

Hawaii - Checklist 2 for pets flying into Kona (KOA), Kahului (OGG), or Lihue (LIH) Airports

If you are traveling to a country that is considered a high-risk country for dog rabies by the CDC and are planning on returning to the United States with your dog, you and your dog may need to meet additional requirements, including specific airports you and your dog are permitted to fly into. Please review the links below.

CDC - High Risk Countries for Dog Rabies

CDC - Updates and Requirements for Dogs Entering from Countries Classified as High Risk for Dog Rabies

Our veterinarian requires all pets pass a negative intestinal parasite exam within one month of travel date and that adult dogs pass a negative heartworm test for all Health Certificates regardless of destination.

Information the United States Department of Agriculture REQUIRES to Complete an Interstate and/or International Health Certificate

Please fill out the required fields below. We will be unable to complete your pet's Health Certificate without this information

Pet's Name*

Does your pet have a valid Pet Passport?*

Yes

No

Not Sure

If your pet has a valid Pet Passport, please state the country or origin

Please provide your pet's microchip number below if known. If you do not know your pet's microchip number or are unsure if they have one, please write "Unknown" If your pet does not have a microchip, please write "N/A" Please note that some countries require pet's to have a microchip prior to vaccinations and/or entry

Microchip Number*

Pet's Age*

Pet's Sex*

Intact Male

Neutered Male

Intact Female

Spayed Female

Unknown

Species (ie: Dog, Cat)*

Breed

Coat Color/Pattern(s)/Marking(s)*

Date of Travel (Estimate is ok if date not known)*

Method of Travel/Transportation (ie: Airplane, Cargo Ship, Train, Car, etc.)*

Name of Airline (or other method of transportation) (ie: American Airlines)*

City, State and Country of Departure*

City, State and Country of Arrival*

Reason for travel (ie moving, vacation, etc)*

Are you planning on returning to the United States?*

Yes

No

Not Sure

Date or Estimated Date of Return to the United States (If Applicable) Please note that depending on your date of return, you may need to have a health certificate re-issued by a veterinarian from the country you are traveling from to enter the United States with your pet.

First and Last Name of Recipient or Consignee (if different from Owner)

Phone Number (if different from Owner)

Email (if different from Owner)

Address of Destination*

Street Address
Street Address Line 2
City
State/Province
Postal Zip Code
Country

OWNER DISCLOSURE. PLEASE READ AND THOROUGHLY AND SIGN BELOW.

I have read and researched all of the applicable information in regard to what I need as an Owner to travel with or without the animal listed above either foreign or domestically.

I have provided Animal Clinic of Grand Prairie with truthful and accurate information pertaining to the animal listed above as well as any and all details in regard to specific information relating to travel, final destination, and recipient of the animal if applicable.

I understand that additional documentation may be required to return to the United States with the animal listed above and that this additional documentation may need to be obtained from a veterinarian or other authorized government official from the country of which the animal will be returning.

I understand Animal Clinic of Grand Prairie is not responsible for completing documentation beyond the Health Certificate. I will not hold Animal Clinic of Grand Prairie responsible for any additional documentation required for the animal listed above to travel foreign or domestically (other than a Health Certificate) that I did not provide them with.

I understand that Health Certificates are submitted electronically to the United States Department of Agriculture (USDA), and for the animal listed above to travel internationally, I have allowed enough time for it to be endorsed and returned prior to the date of embarkation. I am aware that not all countries accept an electronically signed Health Certificates and assume responsibility for scheduling an appointment within a timeframe that allows return mail of a Health Certificate that must be ink-signed and endorsed.

I accept that I am responsible for any and all fees for the USDA endorsement of a Health Certificate which is determined by the number of animals traveling/listed on the Health Certificate and any specific requirements and/or testing required by the country of destination prior to entry.

I have made the proper arrangements with the travel provider (airline, cargo ship, etc.) in advance and have determined what their requirements are in regards to the transportation of the animal listed above. I understand and accept that this is not the responsibility of Animal Clinic of Grand Prairie.

I understand that, due to the preliminary and necessary paperwork and qualification processes involved, Animal Clinic of Grand Prairie requires a non-refundable deposit towards my appointment. This will go towards the cost of my appointment but is not refundable in the event my appointment is missed, canceled, or rescheduled outside of 48 hours. I also understand that if any of the requirements of my health certificate are not met due to my own planning, the airline requirements, or rescheduling outside of the control of ACGP, there will be no refund or credit for services rendered.

Please type your full name below as a signature of acknowledgment of the above statement.*

Full Name:
Date: