International Health Certificate Preliminary Questionaire • Animal Hospital of Lake Villa

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International Health Certificate Preliminary Questionaire

Please take a moment to fill out our international health certificate preliminary questions. Filling this out helps us ensure we have the correct information required for international travel. Please visit https://www.aphis.usda.gov/pet-travel before filling out the form to familiarize yourself with the requirements for travel to your destination country.

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Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Email *

Country you are traveling to with your pet. *

Who is traveling with your pet? *

Pet owner
Authorized individual
Pet transport company
No one

Destination address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Destination phone number *

What number can we reach you at while away on travel?

What means of travel will you be using?

Airplane - Direct flight to destination
Airplane - With layover in another country
Car
Train
Boat - Direct sail to destination
Cruise ship - Visiting multiple countries

Countries your pet will be in before arriving in destination country. *

Please list all!

Date your pet is leaving the United States *

Place your pet is leaving the United States from (airport, seaport, border)

Date your pet is arriving in destination country *

Date you are arriving in destination country *

How many pets are you bringing? *

Age of pet at time of travel. *

What species of pet will you be traveling with? *

Dog
Cat
Other

Select all that apply

If other, please specify *

Does your pet have a microchip? *

Yes
No
Unsure

Date of pet's last rabies vaccine?

Vaccine administered by? *

Veterinarian that will be issuing health certificate
Veterinarian other than veterinarian issuing certificate (will need to provide valid rabies certificate)
I don't know
Pet needs an updated rabies vaccine

Additional documents disclaimer *

I understand that I am responsible for knowing the requirements of entry into the country(s) which I am traveling, and I understand that I am responsible for knowing any additional travel requirements that my airline/cruise/etc may require

Animal Hospital of Lake Villa - 2024

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