Health Certificate Information - Van Dyke Animal Clinic

"*" indicates required fields

Pet information

Name*

Breed ( as specified on rabies certificate)*

Microchip #*

DOB*

Spayed/ neutered*

Yes

Please enclose rabies certificate with date of vaccination, name of vaccine used, lot number and expiration of vaccine

Owner information/traveling with pet

Your Name (must match passport )*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Traveling with pet ?*

Yes

Address at destination*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone at destination*

If pet is traveling alone, name of person receiving pet at destination

First Last

Date of travel*

Departure city*

Mode of transport (flying, cruise , auto)*

Will the pet be in transit in a different country than final destination?*

Yes

If yes, state country*

Will the pet be returning to the US?*

Yes

Date of return travel

For pets returning to the US, in addition to USDA endorsed documents which we will provide, your pet will need to have a current Rabies vaccine and microchip, and you will need to register with the CDC using the following links:

CDC Animal Importation Form | Dog Import Form Instructions

SMS opt-in

By checking this box, you agree to receive SMS updates from Van Dyke Animal Clinic, with updates on patient status and medications for pick up , appointment confirmations and rescheduling options. Text “STOP” to opt out. Message and data rates may apply. View our Privacy Policy.

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Name

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