Travel Health Certificate Pet's Name:Birthdate: MM slash DD slash YYYY Breed:Microchip Number if present (indicate none if no microchip):Tattoo Appearance and location if present (indicate none if not present):Color/Markings:Sex: Male Female Male Neutered Female Spayed Veterinary clinic where you pet had it’s most recent vaccinations performed: Crosslake Vet Hospital Origin of Pet(Location where the pet is currently living)NamePhone numberEmail Address Street Address City State / Province / Region ZIP / Postal Code Current owner of pet(If it is the same as above, leave blank)NamePhone NumberEmail Address Street Address City State / Province / Region ZIP / Postal Code Destination of Pet(Physical location where the pet is going, NO PO boxes)NamePhone NumberEmail Address Street Address City State / Province / Region ZIP / Postal Code Owner of Pet Once at Destination(If it is the same as above, leave blank)Owner of pet once at destination: (If it is the same as above, leave blank)NamePhone numberEmail Address Street Address City State / Province / Region ZIP / Postal Code Purpose of movement (please check/indicate one) Transfer of ownership Travel/Vacation Relocation Departure date: MM slash DD slash YYYY Method of travel (please check/indicate one) Air cabin Air cargo Automobile If traveling by air* Yes No Airline being flown Yes No Airline addressFlight numberCarrier: (If pet is traveling without owner) Purchaser Other Recipient: as listed aboveNameEmail PhoneAddress Street Address City State / Province / Region ZIP / Postal Code
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