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Health Certificate Form

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Health Certificate Form

**We can only perform health certificates for residents of Georgia and Tennessee at this time.

Please print information clearly. Any errors will result in having to complete a new Health Certificate plus any fees associated with doing so. We must have all the records pertaining to the patient’s medical history.

Sender’s Information:

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Phone

Email *

Recipient’s Information:

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Phone

Email *

Pet’s Information:

Name *

Birthdate (must be exact) *

Color *

Gender *

Breed *

Rabies Vaccination Information:

A Rabies Vaccination is required for all dogs and cats 12 weeks of age and older.

Rabies Vaccination Date *

Rabies Vaccination Expiration: *

Manufacturer *

Company *

Lot Number *

Initial or Booster *

Transport information

How is the pet being transported? *

Automobile
Airline
Train

Is the pet being transported by a transport agency? *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Medical Records:

Please attach all medical records including vaccine records, specifically Rabies vaccinations.

Click or drag files to this area to upload. You can upload up to 10 files.

Comment

Health Certificate Form

Health Certificate Form

Sender’s Information:

Recipient’s Information:

Pet’s Information:

Rabies Vaccination Information:

Transport information

Medical Records:

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