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Health Certificate Form

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Broadway Animal Hospital Health Certificate Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pet(s) before your visit.

Legal Name of person physically traveling with pet to be printed on Certificate(Required)
Is this for domestic or international travel?(Required)
Destination address(Required)

NEW CLIENTS: We will need all previous vaccine history to issue a health certificate. Please provide previous veterinary information so that we may reach out prior to your appointment.

Is your pet microchipped?(Required)
Does your pet require a calming medication for travel?(Required)
Does your destination require rabies titre testing?(Required)
**Rabies titre testing results take 15-30 business days to receive. An exam to issue the health certificate cannot be completed until the results are received**
Will you be returning to the USA?(Required)
Date of departure(Required)
*Please verify your specific airlines travel requirements as they may have additional requirements and deadlines for health certificates

An exam MUST be completed within 10 days of your departure in order to issue a health certificate. Please review the USDA APHIS guidelines for your destination prior to scheduling your appointment as each country has different requirements that are subject to change at any time: https://www.aphis.usda.gov/aphis/pet-travel. Please be aware that some countries require the health certificate from us to be ink-signed by the USDA, which may incur additional fees. As this may delay the timeframe that the certificate is finalized, it is highly recommended that your appointment is scheduled as close to the 10 day mark as possible.

**If your destination requires to be ink-signed by the USDA, you must provide an overnight or next day shipping label at your appointment. This shipping label must have your current address as the recipient so that it can be mailed directly to you prior to your departure.**

If your pet is returning to the USA from a High Risk Rabies Country, additional CDC requirements can be found here: https://www.cdc.gov/importation/hcp/dog-importation/instructions-us-issued-rabies-vaccination-form.html

I have reviewed the requirements for import for my destination per the USDA APHIS AND the airline guidelines. I understand and authorize that my pet may require vaccinations and/or additional medical care prior to my departure date per country regulations for import.

Clear Signature
Date(Required)