Travel Health Certificate Pet's Name:Birthdate: Breed:Microchip Number if present (indicate none if no microchip):Tattoo Appearance and location if present (indicate none if not present):Color/Markings:Sex:MaleFemaleMale NeuteredFemale SpayedVeterinary clinic where you pet had it’s most recent vaccinations performed:Crosslake Vet HospitalOrigin 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 ownershipTravel/VacationRelocationDeparture date: Method of travel (please check/indicate one)Air cabinAir cargoAutomobileIf traveling by air*YesNoAirline being flownYesNoAirline addressFlight numberCarrier: (If pet is traveling without owner)PurchaserOtherRecipient: as listed aboveNameEmail PhoneAddress Street Address City State / Province / Region ZIP / Postal Code
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