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)

Email(Required)

Who is paying for health certificate?

Owner

Requestor

Other

If Other, Name of person(Required)

First Last

Horse name(Required)

Horse temperature(Required)

Add another horse(Required)

Yes

Horse name(Required)

Horse temperature(Required)

Full address of place of departure(Required)

Street Address Address Line 2 City State ZIP Code

Full address of destination(Required)

Street Address Address Line 2 City State ZIP Code

Purpose of travel(Required)

Name of shipper(Required)

Address of shipper(Required)

Phone number of shipper(Required)

PLEASE ALLOW 48 HOURS FOR COMPLETION/APPROVAL