Complete this worksheet BEFORE meeting with Dr. Savage, DVM, a USDA Accredited Veterinarian who needs this information to complete your international health certificate. Please note that preparing for travel to some countries can take several months.

OWNER INFORMATION

Owner Name *

First

Last

Owner Phone Number *

Owner Email *

Owner Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

PET INFORMATION

How Many Pets are Traveling (1-5): *

What is the city and country of arrival destination? *

Will you be traveling to other countries aside from the destination listed above? *

Yes
No

List the address and phone number in the destination country where your pet will stay *

Who is accompanying your pet while traveling? *

The owner
A person authorized by the owner
A pet transport company
No one

How is your pet leaving the United States? *

Pet Name *

Pet Species *

Dog
Cat

Pet Date of Birth/Age *

Is your pet vaccinated for rabies? *

Yes
No
I Dont know

Does your pet have a microchip? *

Yes
No
I Dont know

Add a 2nd pet? *

Yes
No

Pet Name *

Pet Species *

Dog
Cat

Pet Date of Birth/Age *

Is your pet vaccinated for rabies? *

Yes
No
I Dont know

Does your pet have a microchip? *

Yes
No
I Dont know

Add a 3rd pet? *

Yes
No

Pet Name *

Pet Species *

Dog
Cat

Pet Date of Birth/Age *

Is your pet vaccinated for rabies? *

Yes
No
I Dont know

Does your pet have a microchip? *

Yes
No
I Dont know

Add a 4th pet? *

Yes
No

Pet Name *

Pet Species *

Dog
Cat

Pet Date of Birth/Age *

Is your pet vaccinated for rabies? *

Yes
No
I Dont know

Does your pet have a microchip? *

Yes
No
I Dont know

Add a 5th pet? *

Yes
No

Pet Name *

Pet Species *

Dog
Cat

Pet Date of Birth/Age *

Does your pet have a microchip? *

Yes
No
I Dont know

Does your pet have a microchip? *

Yes
No
I Dont know

TRAVEL INFORMATION

What date is your pet leaving the United States? *

City of Departure? *

What date will your pet arrive at the destination country? *

Sanford, ME

International Health Certificate Form