Pet Owner Worksheet for Preparing Visit with an Accredited Veterinarian to Complete a Hawaii Certificate of Veterinary Inspection (CVI/”Health Certificate”)

Please complete this form completely PRIOR to your appointment.

Failure to do so may result in delayed processing. Proof of vaccines can be emailed to us at info@heartlandveterinaryil.com. Please note that Hawaii has unique requirements for the transportation of animals. It is the pet owner’s responsibility to research requirements for their pet.

Heartland Veterinary Hospital does not organize or research travel requirements. You must visit https://www.aphis.usda.gov/pet-travel/state-to-state prior to completing this form or your pets travel plans. Enter your destination on this site to start planning what is needed for you and your pet to safely travel together.

Owners Name (please list owner that is traveling with pet):

Owners State Issued ID information (State of issuance):

Owners State Issued ID information (last 4 digits):

Owners State Issued ID information (expiration date):

Owners Date of Birth:

Is owner active military?

How many pets will be traveling with you to Hawaii? (one pet per form)

Pet Name (one pet per form)

Pet Date of Birth (Estimate if exact DOB is not known)

Pet Sex:

Species:

Breed:

Color(s):

Does your pet have a microchip? (required for Hawaii travel)

Yes

Unknown

If you answered yes, please enter microchip number (15 digit, ISO compliant)

U.S. Phone Number:

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address:

Phone Number (Hawaii destination)

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Will your pet be traveling to multiple Hawaiian Islands?

No, only one

Yes, multiple islands, list below.

Please list all Hawaiian Islands pet will travel to:

How are pets traveling to Hawaii?

On the same plane as the owner

On the same plane as the designated person (not the owner)

Pet Transport company AND within 5 days of the owner

Pet Transport company and NOT within 5 days of the owner

Pet Date of Travel:

Pet Date of Arrival to Hawaii:

How long will your pet's stay be?

Airport pet will be arriving at:

Entry Program:

Airline for Entry into Hawaii:

Flight #

Where was your pet's last rabies vaccination given? *If answering "b" a copy of proof of rabies vaccine MUST be submitted to Heartland. Acceptable proof include county-issued rabies certificate or records from a licensed veterinarian. Images of rabies tags are not proof of vaccine.

If you answered "b" in previous question, where was your pet's last rabies vaccination given?

Do you have an approved tick prevention/treatment to administer at least 14 days prior to arrival?

Yes

If you answered "yes" in the previous question, please list the name of the product here.

Has your pet bitten anyone within the last 10 days?

Yes

CAPTCHA

This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.

This questionnaire has been filled out to honestly and to the best of my ability.

Sign above

Hawaii Travel Health Certificate Form

Please complete this form completely PRIOR to your appointment.

How Are We Doing?

How Are We Doing?

Get In Touch