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Pet International HealthCertificate Questionnaire

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Pet International Health Certificate Questionnaire

Owner's Name(Required)

First Last

Email(Required)

Where are you and your pet going (Destination Country or Countries)?(Required)

Does your pet have a passport?(Required)

Yes

No

What is your current address?(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Who will be traveling with the pet?

The owner

Pet transport company

No one (in cargo)

Other

If other, please specify(Required)

Name of person traveling with pet as stated on passport(Required)

Please list the FULL ADDRESS of the destination country you will be traveling to:(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Telephone(Required)

International Telephone (if any)

Date of your flight(Required)

Time of your flight(Required)

:

Airline Company(Required)

Departing Airport(Required)

Arrival Date & Time of your flight(Required)

Name of pet (s)(Required)

Age(Required)

Sex(Required)

INTACT MALE

MALE NEUTERED

INTACT FEMALE

FEMALE SPAYED

Does your pet have a microchip?(Required)

Yes

No

Date of Microchip implantation(Required)

Is your pet on heartworm prevention?(Required)

Yes

No

If so, please give us the name and date of the last does given.(Required)

Is your pet on flea/tick prevention?(Required)

Yes

No

If so, please give us the name and date of the last does given.(Required)

Date of last fecal test

Results of last fecal test

Name

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

Form

Pet International HealthCertificate Questionnaire

Pet International Health Certificate Questionnaire

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