International Travel Health Certificate Form

Pet Owner Worksheet for Preparing Visit with an Accredited Veterinarian to Complete an International 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 each country has unique requirements for 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/us-to-another-country-export 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):

Pet Name (one pet per form):

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

Pet Gender:

Species:

Does your pet have a microchip? (required for International 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 (Country of destination):

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

How are pets traveling to destination country?

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:

Countries pet will be stopping anywhere on the way (flight layover/connections):

How long will your pet's international stay be?

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?

Has your pet bitten anyone within the last 10 days?

Yes

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International Travel Health Certificate Form

Please complete this form completely PRIOR to your appointment.

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