Canyon Falls - Pet Owner Woksheet

Pet Owner Worksheet

For International and Domestic Travel Health Certificates.

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email

Phone

Please complete this worksheet BEFORE meeting with the USDA Accredited Veterinarian who needs this information to complete your international health certificate.

Pet Name:(Required)

What is the species and breed of your pet?*

Species(Required)

Breed(Required)

Will you be permanently moving to this country or just visiting(Required)

Permanently Moving

Just Visiting

Please list the destination country you are traveling to with your pet:(Required)

Who will be accompanying the pet while traveling?(Required)

The owner

A person authorized by the owner

No one

A pet transport company is transporting the pet

Please list the address and phone number in the destination country where your pet will stay:*

Address:(Required)

Phone Number:(Required)

Please list any additional addresses and phone numbers in the destination country where your pet will stay:

How is your pet leaving the United States:*(Required)

a. Air - Direct Flight

b. Air - Layovers in another country *You will need to list the other country/countries

c. Car

d. Train

e. Boat - Direct

f. Boat - Cruise Ship *You will need to list the other country/countries

If you answered b to the question above and will be traveling by air with layovers in another country, please list the country or countries your pet will land in before the destination country is reached.

Country or countries your pet will land in before the destination country is reached.(Required)

If you answered f to the question above and will be traveling by cruise ship please list all the countries where the ship will be stopping.

List all the countries where the ship will be stopping.(Required)

On what date, and from where is your pet leaving the United States (last air or seaport in the US)?*

Date(Required)

MM slash DD slash YYYY

Location

Please provide the date you and your pet will arrive in the destination country:*

Date you Arrive(Required)

MM slash DD slash YYYY

Date you pet arrives(Required)

MM slash DD slash YYYY

When will your pet be returning to the United States? if pet will not be returning, please type N/A.

When will your pet be returning to the United States? *if pet will not be returning, please type N/A.*(Required)

How many pets are traveling?*(Required)

How old will your pet be on the date of travel?*(Required)

Does your pet have a microchip?*(Required)

Yes

No

I don't know

If your pet has a microchip, when was it implanted?

When was your pet's last rabies vaccination?(Required)

The veterinarian issuing my international health certificate administered my pet’s last rabies vaccination.(Required)

Yes

No

I don't know

A veterinarian other than the veterinarian issuing my international health certificate administered my pet’s last rabies vaccination. I will need to bring the last valid rabies certificate to my appointment.(Required)

Yes

No

I don't know

My pet isn't vaccinated for rabies.(Required)

Yes

No

I don't know

Does your destination country require an import permit?*(Required)

Yes

No

I don't know

Does your airline or cruise ship have any additional requirements?*(Required)

Yes, and I will give them to the veterinarian issuing the certificate.

No

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