Domestic Health Certificate

Alternate Current for

Certificate of Veterinary Inspection (CVI) valid for 30 days from date of issue.
Appointment must be scheduled within 30 days of your departure date.
Canada & Mexico: vaccine certificate + up-to-date rabies vaccine required. No USDA endorsement needed.

Client & Pet Information

Client Name *

First

Last

Please enter your legal name exactly as it appears on your passport/ID. Incorrect names may result in your health certificate being denied for travel.

Phone Number *

Email Address *

Home Address *

Address Line 1

Address Line 2

City

State

Zip Code

Emergency / Alternate Contact Name

Emergency / Alternate Phone

Pet's Name *

Species *

Dog
Cat

Sex *

Male
Female

Breed *

Color / Markings *

Date of birth (or approx. age) *

Weight (if known) *

Your pet is.. *

Spayed/Neutered
Intact

Microchip Number *

ISO-compliant microchips are required for Hawaii and most international destinations. If your pet's chip is not ISO-compliant, an additional chip may need to be placed.

ISO (15 Digits) compliant? *

Yes
No
Unknown

Destination state(s) *

Single state
Multiple states

Single state *

List all destination states: *

Planned Departure Date *

Approximate Return Date (if applicable)

Method of travel *

Air — Passenger Cabin
Air — Cargo
Ground / driving

Airline / Carrier Name (if flying):

Flight number(s) and travel date(s):

Origin address (traveling from)

Destination address (traveling to)

Is this a round trip?

Yes
One-way

Return Date

Vaccination & Preventive Care History

Is your pet's rabies vaccine current? *

Yes
No
Unsure

Date of most recent rabies vaccine *

Vaccine type (1-year or 3-year, if known)

Current veterinary clinic (if not A Pet's Place)

Other vaccines currently up to date (check all that apply) *

Please Specify *

Current on heartworm/flea/tick prevention? *

Yes
No
Unsure

New client? *

Yes
No

Please upload previous veterinary records below or email them to apetsplaceah@gmail.com. Records must be received at least 24 hours prior to your first appointment.

Drag & Drop Files, Choose Files to Upload

Health History

Known medical conditions or chronic health issues? *

Yes
No

If yes, please describe: *

Currently on any medications or supplements? *

Yes
No

If yes, list name(s) and dosage: *

Known allergies (food, environmental, or medication)? *

Yes
No

If yes, please describe: *

Aggression / special handling notes for the exam:

Additional questions or special requests:

Authorization & Signature

I confirm *

I confirm that the information provided on this form is accurate and complete to the best of my knowledge. I authorize A Pet's Place Animal Hospital to perform a physical examination and any diagnostics necessary to complete the requested health certificate.

Important Travel Disclaimer

Pet travel requirements may change at any time and can vary depending on the state and airline. A health certificate does not guarantee entry into a destination, and it remains the pet owner’s responsibility to verify and comply with all applicable travel requirements.

Now Accepting New Clients!

Travel Within the United States with Confidence

Valid for 30 Days

For Interstate Travel

Simple Process

Healthy & Safe

What to Expect

Traveling to Canada or Mexico?

Pricing

Domestic Health Certificate