International Health Certificate Checklist - Wasatch Hollow Animal Hospital

Intended Destination*

Date of Intended Departure:*

Date of Intended Arrival:*

Local Owner Information

Full Name:*

First Last

Local Address:*

Street Address City State ZIP Code

Email*

Local Phone Number:*

Destination Information

Address of location pet will be staying and contact information of responsible party – may or may not be the owner if someone else will be accompanying pet.

Full Name:*

Person Accompanying Pet

First Last

Destination Address:*

Street Address City State / Province / Region ZIP / Postal Code Country

Destination Phone Number:*

Pet Information

Name*

Age*

Sex*

Male
Male Neutered
Female
Female Spayed

Species*

Dog
Cat

Microchip Number*

Date Microchip Placed*

Be aware most countries require microchips to be in place prior to travel, some even require microchip to be in place prior to vaccinating – this timeline is critical to your travel ability. Please contact the USDA for your country’s requirements.

Vaccine History

We must have hard copies of vaccination history and Rabies Certificate at least 24 hours prior to Health Certificate appointment if vaccines were not done at Wasatch Animal Hospital. Any vaccines not current or without proper documentation will need to be updated based on destination requirements before the health certificate can be issued.

Date Vaccines Were Administered Last

Rabies

DHPP (Canine Distemper)

Leptospirosis

Bordetella

Canine Influenza

FVRCP (Feline Combo Vaccine)

For other species of pets, please provide any vaccinations that your pet has received. If none, please write "none".

Other Species Vaccines

Does your destination require vaccine titers?*

Yes
No

Obtaining vaccine titers is a process that can span weeks or months. This timeline may interfere with travel plans and must be researched thoroughly.

Parasite Prevention

Many countries recommend specific products be used at pre-determined timelines, and may require application or administrations of medications to be supervised by a veterinarian. Please be sure to contact the USDA for specific guidelines based on your travel plans.

Heartworm Prevention Brand Name:

Date Last Given:

External Parasite Prevention Brand Name:

Date Last Given:

Internal parasite treatment required?*

Yes
No
Unsure

Internal Parasite Treatment Product:

Date(s) Required:

Health Certificate Requirements

Work with your veterinarian to complete all required paperwork. Please consult our APHIS pet travel website to access the required certificate/form, when available.

After your health certificate has been completed, signed, and dated by your veterinarian, most countries require that international health certificates be submitted to a USDA APHIS Veterinary Services office for endorsement. Some offices offer to review health certificates prior to submission.

Please work with your endorsing USDA office to determine your options for paperwork review and/or submission.

Consent*

I have read and understand the Health Certificate requirements outlined above, and completed this form to the best of my knowledge.

Name

This field is for validation purposes and should be left unchanged.