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Health Certificate Preparation Form

Local Address and Shipper Information

Address

Destination Address and Consignee Information

Address

Travel Information

Means of Transport

Pet Information

If yes, please email it to the clinic within 24 hours of submitting this form.
If yes, please email it to the clinic within 24 hours of submitting this form.

Add a Second Pet

If yes, please email it to the clinic within 24 hours of submitting this form.
If yes, please email it to the clinic within 24 hours of submitting this form.

Declaration of Responsibility and Understanding

I understand that in issuing a Health certificate, the veterinarian must verify that, to the best of their knowledge, my pet is free of communicable disease including internal and external parasites. In order to verify they are free of internal parasites, my pet must be tested today or treated with a dewormer. I authorize Smithfield Animal Hospital to perform the necessary test if they can get a sample. If they are not able to get a sample or parasites are identified on the test, I authorize Smithfield Animal Hospital to provide an appropriate deworming treatment. In order to verify that my pet is free of external parasites, my pet must be current on a flea and tick preventative. If they are not, I authorize Smithfield Animal Hospital to administer a preventative today. My pet may require additional vaccines or tests depending on the specific requirements of the country or state I am traveling to and these will be discussed during the health certificate appointment.

I have reviewed the requirements for my pet to travel at aphis.usda.gov and have fulfilled all the requirements of my destination country or state and by the airline or shipper that I am using. If I have declined any tests or services recommended to me by Smithfield Animal Hospital, I acknowledge that I have accepted the risk that my pet may be turned away at their destination or quarantined until any necessary services are rendered at my expense. I have answered the above questions truthfully to the best of my knowledge.

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