Health Certificate for US Pet Travel
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Transcript of Health Certificate for US Pet Travel
Consignor/Origin Owner (if different from consignor)Name NameAddress Address Phonenumber Phonenumber
Consignee/Destination Name Address Phonenumber
Animal Name Age Sex M F NeuteredSpecies Breed Weight Color/markings Microchip
Other Information
Rabies—Product NameDate TypeManufacturerSerialNumberTag
Test/Vaccine/otherProductname/typeDate
Test/Vaccine/other Productname/typeDate
Test/Vaccine/other Productname/typeDate
Test/Vaccine/other Productname/typeDate
Test/Vaccine/other Productname/typeDate
Test/Vaccine/other Productname/typeDate
Additional comments/Weather Acclimation Statement
Veterinary Certification Statement IcertifythatIhaveexaminedtheanimaldescribedandtothebestofmyknowledgeandbeliefattesttothestatementsindicated:(Check applicable statements)
Notshowingsignsofinfectious,contagious,and/orcommunicabledisease.Theanimalappearshealthyfortransport.
Veterinarian’sSignaturePrintednameTelephonenumber License&/oraccreditationnumber Licensingstate
Consignor /Owner Certification Statement Consignor/OwnerCertification:IcertifythattheinformationconcerningtheanimaldescribedaboveistrueandcorrectandthatIamtheconsignor/ownerofsuchdescribedanimalandthatIhavephysicalandlegalcustodyofsuchanimal.Tothebestofmyknowledge,theanimalhashadnoknownexposuretocommunicablediseasewithinthelast30days.Theanimalhasnotbittenanyonewithinthelast10days.
Consignor/OwnerSignaturePrintedname
CertificateofVeterinaryInspection