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International and Domestic Health Certificates
Form

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Broadway Animal Hospital International and Domestic Health Certificates
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 traveling with pet printed on Certificate *

Is this for domestic or international travel? *

Domestic Travel(United States, Mexico, or U.S Territories)
International travel(includes Hawaii)

Destination address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Phone number you will be using during travel *

Current USA residential address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone number of person traveling with pet *

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.

Name of previous veterinary clinic that your pet received their vaccinations *

Phone number of veterinary clinic *

Is your pet microchipped? *

Does your pet require a sedative for travel? *

Does your destination require rabies titre testing? *

**Rabies titre testing results take 6-8 weeks to receive. An exam to issue the health certificate cannot be completed until the results are received**

Date of departure *

Date of re-entry *

Airline(s) or Port of Departure (land travel) *

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: 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.

Signature *

Clear Signature

Date *

International and Domestic Health Certificates Form

Broadway Animal Hospital International and Domestic Health Certificates Form

International and Domestic Health Certificates
Form

Broadway Animal Hospital International and Domestic Health Certificates
Form