Pet and Travel Information Form

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 of 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: (Please indicate age in either weeks, months or years)*

Pet's Sex:*

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

Do you have a Certification of US-Issued Rabies Vaccination form endorsed by the USDA?

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:

In order to complete your health certificate, please send your pet's current vaccination records, recent medical history, and proof of microchip (when applicable) to acgpvets@gmail.com for our veterinarian to review.

A booking fee of $75 will be collected at the time of confirming and scheduling your appointment, once our veterinarian has reviewed your records. This fee will be applied to your balance at the time of your appointment, but is non-refundable in the case that you don’t cancel or reschedule within a 48 hour timeframe.

In some cases, wherein administrative work exceeding 1 hour will need to be performed prior to accepting your case, a non-refundable consultation fee of $75 will be collected. This covers the time and labor necessary in order to admit your pet for the health certificate process, and ensure that all necessary requirements have been or will need to be met. This is usually the case when there have been multiple services performed at other facilities, such as lab testing, vaccines, etc. We recommend staying at one facility, and a veterinarian that is USDA accredited, in order to alleviate any possible complications.

Please type your signature in this box to signify that you have read and understood the requirements, stipulations, and procedures outlined in both the “Additional Information & Owner Disclosure Form” and the “Pet & Owner Travel Information Form.”

Full Name:
Date:

Pet and Travel Information Form

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

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

Pet's Age: (Please indicate age in either weeks, months or years)*

Pet's Sex:*

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?*

Do you have a Certification of US-Issued Rabies Vaccination form endorsed by the USDA?

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:*

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:*