Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Contact Phone Number *

Email Address *

Pet's Name *

Type of pet *

Breed *

Pets date of birth *

Sex *

Male
Female

Spayed or Neutered *

Yes
No

Coloring or distinctive markings *

Has your pet traveled outside of the United States in the last 6 months? *

Yes
No

If yes, what country? *

Country that you are taking your pet to *

Is it a direct flight? *

Yes
No

If not, which country is your layover? *

Date that you plan on leaving *

What date do you plan on returning to the United States? *

Date of your pet’s last rabies vaccination *

Do you have an original copy of the Rabies vaccination certificate? *

Yes
No

Does your pet have a current Certification of U.S. Issued Rabies Vaccination Form? *

Yes
No
not sure

Does your pet currently have a microchip? *

Yes
No

Microchip number *

Date Microchip was implanted *

Name of person accompanying your pet on the flight: *

Is it yourself on the same flight with the pet, a designated person, or a transport company? *

Are you working with a travel company to expedite the travel process? *

Yes
No

What port are you leaving from? *

What type of admission are you applying for? Permanent or temporary? *

Name, Address, and phone number in the country of import *

If traveling to the European Union does your pet have an EU Pet Passport? *

Yes
No

We require the following documents:

A physical hard copy of the actual rabies certificate brought to the office or a .pdf (NOT a picture, jpeg,etc) of the rabies certificate from the veterinarian that administered the vaccination showing date of administration, expiration of the vaccine, lot number of the vaccine, and vaccine manufacturer.
Record of the date when the microchip was implanted.
Record of all vaccinations
Record of any deworming
Record of any rabies titer testing if applicable

The cost of each required examination at the East Rockaway Veterinary Hospital is $101. The cost for each international health certificate ranges from $500-$1500 depending on the country. Vaccines, parasite medication, or any lab work is additional and separate from the examination fee. The USDA endorsement fees and any shipping/postage fees will be paid directly to the hospital. Some countries require multiple lab tests, parasite treatments, and multiple visits so please plan ahead. This process can take weeks to months. We will not be able to accommodate clients that are trying to leave in less than 14 days. Please include any previous records including vaccination and microchip information with this questionnaire. Return questionnaire via fax at 516-596-0310 or email erockvet@gmail.com. Please make your appointment way ahead of time. Sorry but no International Health Examinations are performed on Saturdays. Please be aware that there is a $101 NONREFUNDABLE deposit that must be paid before the process can start. This fee will be used towards the cost of the examination. Thank you

Digital Signature stating that I understand that the $101 fee is non-refundable *

Online form

International Health Certificate Questionnaire

International Health Certificate Questionnaire Form

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