Southern Crescent Equine Services - Health Certificate Request

Please note that only horses for the same owner can be on the same health certificate. Each owner will need to request their own health certificate for their horse(s).

Date leaving(Required)

Date requested(Required)

Name of person requesting certificate(Required)

First Last

Phone number(Required)

Email(Required)

Horse Owner(Required)

First Last

Phone number(Required)

Who is paying for health certificate?

Owner

Requestor

Other

If Other, Name of person(Required)

First Last

Horse Name(Required)

Horse Temperature(Required)

Coggins Upload

Max. file size: 8 MB.

A current Coggins is required for a Health Certificate to be processed. If you have one that was pulled someplace other than SCES please upload it here.

Do you wish to add a horse?(Required)

Horse 2 Name(Required)

Horse 2 Temperature(Required)

Horse 2 Coggins Upload

Max. file size: 8 MB.

A current Coggins is required for a Health Certificate to be processed. If you have one that was pulled someplace other than SCES please upload it here.

Horse 3 Name

Horse 3 Temperature

Horse 3 Coggins Upload

Max. file size: 8 MB.

A current Coggins is required for a Health Certificate to be processed. If you have one that was pulled someplace other than SCES please upload it here.

Horse 4 Name

Horse 4 Temperature

Horse 4 Coggins Upload

Max. file size: 8 MB.

A current Coggins is required for a Health Certificate to be processed. If you have one that was pulled someplace other than SCES please upload it here.

Horse 5 Name

Horse 5 Temperature

Horse 5 Coggins Upload

Max. file size: 8 MB.

A current Coggins is required for a Health Certificate to be processed. If you have one that was pulled someplace other than SCES please upload it here.

Name

Full address of place of departure(Required)

Street Address City State ZIP Code

Phone Number

Name

Full address of destination(Required)

Street Address City State ZIP Code

Phone Number

Purpose of travel(Required)

Name of shipper(Required)

Address of shipper(Required)

Phone number of shipper(Required)