Travel Documents / Health Certificate Form

What Country, State, or US territory is your pet traveling to?*

Date of departure*

The physical address your pet(s) are leaving from (No PO Boxes)*

Who is accompanying your pet while traveling?*

Myself, the owner

A person authorized by the owner

A pet transport company

No one

To be completed only if the pet is traveling with anyone other than the owner! Please list the name, phone number and email address for the person/company your pet will be traveling with:*

How will your pet be traveling?*

Car

Boat - Direct

Boat - Cruise Ship

Plane

Plane - With layovers in other countries

Other

(International travel only) If traveling by plane or boat with stops or layovers in other countries, please list all countries your pet will land/stop in before destination country is reached:

Name of person the pet is going to at destination country (list yourself if your pet is remaining with you)*

First Name
Last Name

Please Enter Phone Number, and physical address where your pet will be staying in your destination country (No PO Boxes)*

Does your destination require an import permit?*

Yes, I already have one

Yes, but I have not gotten it yet

No

I don't know, but will confirm with the airline and/or destination country.

Does your airline or cruise ship give you any additional travel requirements for your pet?*

Yes, I will email details to coastal@coastalanimalhospital.com

No

(International travel only) If traveling to another country, will you be returning to the USA?

Yes

No

(International travel only) If yes, provide and estimated date of return?

How many Pets are you traveling with?*

Please list the name(s), Microchip Number(s), Microchip implant date(s), date of birth, species (Cat or dog), and breed for each pet you will be traveling with:*

Does your pet/any of your pets have a second microchip?*

Yes

No

If yes, please list the pets name and their additional micochip number(s)

If your pet sees another Veterinary Clinic/Hospital please list their name, phone number and email address: (Write none if your pet is not seen elsewhere)*

If you have a copy of your pet's records from another veterinary hospital/clinic, or vaccine clinic you will email them to coastal@coastalanimalhospital.com*

Yes

No (not applicable)

(International travel only) Does your pet have an EU Passport? (if yes, email them to coastal@coastalanimalhospital.com)*

Yes

No (Not Applicable)

Any additional notes, comments, or questions:

To schedule my appointment, I prefer to be contacted by*

Text Message

Email

Phone Call