Travel Health Certificate Form – Union Pet Hospital

Owner's Name *

First

Last

Email *

Owner's Address *

Address Line 1

Address Line 2

City

State

Zip Code

Pet Information

(Please complete for each pet.)

Pet's Name *

Species *

Dog
Cat

Breed *

Pet's Date of Birth or Age *

Sex *

Male
Male Neutered
Female
Female Spayed

Color/Markings *

Pet's Microchip Number *

Date of Microchip implantation *

Current Veterinary Hospital (if not Union Pet Hospital)

Do you have second pet ? *

Yes
No

Pet's Name *

Species *

Dog
Cat

Breed *

Pet's Date of Birth or Age *

Sex *

Male
Male Neutered
Female
Female Spayed

Color/Markings *

Pet's Microchip Number *

Date of Microchip implantation *

Current Veterinary Hospital (if not Union Pet Hospital)

Do you have third pet ? *

Yes
No

Pet's Name *

Species *

Dog
Cat

Breed *

Pet's Date of Birth or Age *

Sex *

Male
Male Neutered
Female
Female Spayed

Color/Markings *

Pet's Microchip Number *

Date of Microchip implantation *

Current Veterinary Hospital (if not Union Pet Hospital)

Microchip Microchip Please

Travel Information

Travel Destination Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Purpose of Travel *

Vacation
Permanent Relocation
Other

Other: *

Date Leaving the United States *

Expected Return Date (if applicable)

Method of travel? *

Driving
Flying

Who is traveling with the pet? *

First

Last

Flight Information (If Flying)

Airport (Example: You may fly from CVG → Atlanta → Paris. The international departure airport would be Atlanta.) *

Airline *

Will your pet travel *

In Cabin
Cargo

Do you already have flights booked? *

Yes
No

Medical Information

Is your pet current on Rabies vaccination? *

Yes
No
Unsure

Please attach: Vaccination Records

Drag & Drop Files, Choose Files to Upload

Medical records (if from another veterinarian)

Drag & Drop Files, Choose Files to Upload

Rabies certificate(s)

Drag & Drop Files, Choose Files to Upload You can upload up to 3 files.

Has your pet previously traveled internationally? *

Yes
No

If yes, where? *

Does your pet have a Pet Passport? (Ex: EU Passport) *

Yes
No

If yes, please attach a copy or bring to consultation *

Drag & Drop Files, Choose Files to Upload

Documentation

Do you already have

Country Import Instructions
Airline Requirements
Pet Relocation Company Instructions

Please attach any documents you have received

Drag & Drop Files, Choose Files to Upload You can upload up to 3 files.

Additional Questions

Are you working with a pet relocation company?

Yes
No

If yes, which company?

Is there anything else you would like our team to know before your consultation?

IHC Consultation Form

Pet Information

Travel Information

Flight Information (If Flying)

Medical Information

Documentation

Additional Questions

We provide exceptional pet care in Union, KY!

Address

Contact Us

Hours