International Health Certiifcate Form

This information is needed for International Health Certificates and for clients traveling to Hawaii. Please answer the below questions to help us complete your health certificate.

What type of movement is this?*

Commercial

Non-Commercial

Destination Country*

Departure Date*

Arrival Date*

Trip Duration*

Temporary

Permanent

Method of Travel*

Air Cabin

Cargo

Airline

Flight #

Port of Arrival

Your Name (Owner)*

Origin

Country*

Origin Address*

Street
City
State/Province
Postal Code

Phone Number*

Email*

Destination

Country*

Location Name (Example - Home in Switzerland)*

Address*

Street
City
State/Province
Postal Code

Phone Number*

Travel Info

Carrier*

Owner

Other Carrier

If you selected "Other Carrier" above, please provide the following:

First Name
Last Name
Phone
Email
Address
City
State/Province
Postal Code
Country

Pet #1

Information*

Name
Species
Breed
Age
Birthdate
Sex
Spayed/Neutered?

Microchip Information

Microchip #
Microchip Company (ex: Home Again)
Microchip Implantation Date
Is the Microchip ISO compliant?
Does this pet have another readable Microchip?

Dates of the last three Rabies Vaccines
*Email rabies certificate to info@rosecityvet.com (unless given at RCVH)**

1
2
3

If FAVN Testing has been done, please provide the following:

Date of Test
Results

Pet #2

Information

Name
Species
Breed
Age
Birthdate
Sex
Spayed/Neutered?

Microchip Information

Microchip #
Microchip Company (ex: Home Again)
Microchip Implantation Date
Is the Microchip ISO compliant?
Does this pet have another readable Microchip?

Dates of the last three Rabies Vaccines
Email rabies certificate to info@rosecityvet.com (unless given at RCVH)

1
2
3

If FAVN Testing has been done, please provide the following:

Date of Test
Results

International Health Certiifcate Form

What type of movement is this?*

Destination Country*

Departure Date*

Arrival Date*

Trip Duration*

Method of Travel*

Airline

Flight #

Port of Arrival

Your Name (Owner)*

Origin

Country*

Origin Address*

Phone Number*

Email*

Destination

Country*

Location Name (Example - Home in Switzerland)*

Address*

Phone Number*

Travel Info

Carrier*

If you selected "Other Carrier" above, please provide the following:

Pet #1

Information*

Microchip Information

Dates of the last three Rabies Vaccines Email rabies certificate to info@rosecityvet.com (unless given at RCVH)*

If FAVN Testing has been done, please provide the following:

Pet #2

Information

Microchip Information

Dates of the last three Rabies Vaccines Email rabies certificate to info@rosecityvet.com (unless given at RCVH)

If FAVN Testing has been done, please provide the following:

Dates of the last three Rabies Vaccines
*Email rabies certificate to info@rosecityvet.com (unless given at RCVH)**

Dates of the last three Rabies Vaccines
Email rabies certificate to info@rosecityvet.com (unless given at RCVH)