Worksheet - International Health Cert.

International Health Certificate

Pre-Registration

Are you a current client of Newberry Animal Hospital?

Yes

Please fill out a New Client Form in addition to this form

Pet Owner/Client Name:

Pet Owner/Client Current Address

Pet Owner/Client Phone Number

Pet Owner/Client Email:

Every foreign country has specific requirements for International Health Certificates. Newberry Animal Hospital requires a non-refundable deposit of $250 to start researching these requirements and to schedule an appointment for your pet(s) international health certificate(s). This deposit may be left over the phone or in-hospital at any time. Once this form has been submitted, a trained staff member will be in contact with you within 3 business days regarding the travel requirements for your destination country and scheduling your pet's International Health Certificate appointment.

I understand the required agreement listed above

I do not understand the required agreement listed above and would like to be contacted about the International Health Certificate Process

Please select

Please indicate the destination country that you are traveling to with your pet(s):

DEPARTURE DATE

RETURN DATE

List the address(s) in the destination country where your pet(s) will stay during your visit.

List the phone number(s) that will be used in the destination country where your pet(s) will stay during your visit.

Does your destination country require an import permit?

Yes

I don't know.

Did your airline/cruise ship/travel service give you any additional travel requirements for your pet(s)?

Yes, I will give this to the veterinarian issuing my international health certificate.

Please list/provide a link for any additional travel requirements

Please upload any additional travel requirements

Delete all uploads

Choose files or drag here

Required Agreement:

I understand that Newberry Animal Hospital only evaluates the requirements needed for my pet to enter the specific country I am traveling to - NOT the requirements of the airlines, ports, or transport companies I am using to get there. I understand it is my responsibility to provide Newberry Animal Hospital with any additional requirements placed upon me by my travel service(s) and will list/link/upload them where applicable.

Please select

Is the pet traveling on the same plane as you or the authorized person?

Yes

How is your pet(s) leaving the United States?

a. Air - Direct flight

b. Air - Layovers in another country. List (below) the country or countries your pet will land in before the destination country is reached:

c. Car

d. Train

e. Boat - Direct

f. Boat - Cruise ship - List (below) all countries the cruise is stopping at:

If you selected (b) or (f) above, please add details HERE:

Please be aware that if you have a layover in another country before your final destination, your pet will need to meet both the layover country and final destination country's requirements for international travel.

Does your travel itinerary include a layover in a country that is different from your destination?

Yes

Would you like Newberry Animal Hospital to perform an additional health certificate for your layover country?

Yes

I understand that there is a possibility that my pet(s) may require an additional international health certificate for their layover in a country that is different than their destination. As the owner of this pet(s), I am refusing the international health certificate for my pet's layover. I agree to not hold Newberry Animal Hospital responsible if my layover country requires an international health certificate and my pet's travel is interrupted.

I agree to the above statement

What date is your pet(s) leaving the United States?

YYYY

What air or seaport will your pet(s) depart from when leaving the United States?

What date will YOU or the person you authorized, arrive in the 'destination country'?

YYYY

What date will YOUR PET(s) arrive in the 'destination country'?

YYYY

PET #1 INFORMATION

Pet #1: What is the name of the pet that is traveling?

Pet #1: How old will this pet be on the departure date of travel?

Pet #1: What type of pet will be traveling?

a. Dog

b. Cat

c. Ferret

d. Bird (other than: chickens, doves, ducks, geese, grouse, guinea fowl, partridges, pea fowl, pheasants, pigeons, quail, swans, and turkeys)

e. Rodent

f. Hedgehog/tenrec

g. Rabbit

h. Reptile

i. Amphibian

Pet #1 Does your pet have a microchip?

a. Yes, I have listed the date of implant below.

b. Yes, but I do not know when it was implanted.

c. I have more than one pet but not all of them have microchips.

d. No.

e. I don't know.

Pet #1: If you answered (a) above, please add microchip date HERE:

Pet #1: When was this pet's last rabies vaccination?

a. The veterinarian issuing my international health certificate administered my pet's last rabies vaccination, on the date listed BELOW.

b. 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, but the vaccination date is listed BELOW.

c. I don't know.

d. My pet isn't vaccinated for rabies.

Pet #1: If you answered (a) or (b) above, please add date of rabies vaccination HERE:

Do you have a second pet that is also traveling on this trip?

Yes

Pet #2: What is the name of the pet #2 that is traveling?

Pet #2: How old will this pet be on the departure date of travel?

Pet #2: What type of pet will be traveling?

a. Dog

b. Cat

c. Ferret

d. Bird (other than: chickens, doves, ducks, geese, grouse, guinea fowl, partridges, pea fowl, pheasants, pigeons, quail, swans, and turkeys)

e. Rodent

f. Hedgehog/tenrec

g. Rabbit

h. Reptile

i. Amphibian

Pet #2: Does your pet have a microchip?

a. Yes, I have listed the date of implant below.

b. Yes, but I do not know when it was implanted.

c. I have more than one pet but not all of them have microchips.

d. No.

e. I don't know.

Pet #2: If you answered (a) above, please add microchip date HERE:

Pet #2: When was this pet's last rabies vaccination?

a. The veterinarian issuing my international health certificate administered my pet's last rabies vaccination, on the date listed BELOW.

c. I don't know.

d. My pet isn't vaccinated for rabies.

Pet #2: If you answered (a) or (b) above, please add date of rabies vaccination HERE:

Do you have a third pet that is also traveling on this trip? (this form only allows for 3 pets)

Yes

Pet #3: What is the name of the pet #3 that is traveling?

Pet #3: How old will this pet be on the departure date of travel?

Pet #3: What type of pet will be traveling?

a. Dog

b. Cat

c. Ferret

d. Bird (other than: chickens, doves, ducks, geese, grouse, guinea fowl, partridges, pea fowl, pheasants, pigeons, quail, swans, and turkeys)

e. Rodent

f. Hedgehog/tenrec

g. Rabbit

h. Reptile

i. Amphibian

Pet #3: Does your pet have a microchip?

a. Yes, I have listed the date of implant below.

b. Yes, but I do not know when it was implanted.

c. I have more than one pet but not all of them have microchips.

d. No.

e. I don't know.

Pet #3: If you answered (a) above, please add microchip date HERE:

Pet #3: When was this pet's last rabies vaccination?

a. The veterinarian issuing my international health certificate administered my pet's last rabies vaccination, on the date listed BELOW.

c. I don't know.

d. My pet isn't vaccinated for rabies.

Pet #3: If you answered (a) or (b) above, please add date of rabies vaccination HERE:

Owner/Client Signature:

Date of pre-registration submission:

2025