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WSAH International Health Certificate Form

Save time during your next appointment. Complete your WSAH international health certificate form online from any device at any time before your visit.

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WSAH International Health Certificate Form

Please fill out this form as completely and accurately as possible.

Complete this worksheet BEFORE meeting with Dr. Savage, DVM, a USDA Accredited Veterinarian who needs this information to complete your international health certificate.

Please note that preparing for travel to some countries can take several months.

OWNER INFORMATION

Owner Name: *

Owner Address: *

Address Line 1

Address Line 2

City

State

Zip Code

Owner Phone Number: *

Owner E-mail: *

PET INFORMATION

How Many Pets are Traveling (1-5): *

Pet Name:

Pet Species:

Pet Date of Birth/Age:

Is your pet vaccinated for rabies?

Yes
No
I Dont know

Vaccination Date

Who administered your pet’s last rabies vaccination?

The veterinarian issuing my international health certificate
A veterinarian other than the veterinarian issuing my international health certificate

What is the name, address, and phone number of your pet’s previous veterinarian(s)?

You will need to bring the last valid rabies certificate to the appointment.

Does your pet have a microchip:

Yes
No
I Dont know

Microchip Number:

Date It was implanted on ( put "I dont know" if you aren't sure):

Add another pet?

Pet Name:

Pet Species:

Pet Date of Birth/Age:

Is your pet vaccinated for rabies?

Yes
No
I Dont know

Vaccination Date

Who administered your pet’s last rabies vaccination?

The veterinarian issuing my international health certificate
A veterinarian other than the veterinarian issuing my international health certificate

What is the name, address, and phone number of your pet’s previous veterinarian(s)?

You will need to bring the last valid rabies certificate to the appointment.

Does your pet have a microchip:

Yes
No
I Dont know

Microchip Number:

Date It was implanted on ( put "I dont know" if you aren't sure):

Add another pet?

Pet Name:

Pet Species:

Pet Date of Birth/Age:

Is your pet vaccinated for rabies?

Yes
No
I Dont know

Vaccination Date

Who administered your pet’s last rabies vaccination?

The veterinarian issuing my international health certificate
A veterinarian other than the veterinarian issuing my international health certificate

What is the name, address, and phone number of your pet’s previous veterinarian(s)?

You will need to bring the last valid rabies certificate to the appointment.

Does your pet have a microchip:

Yes
No
I Dont know

Microchip Number:

Date It was implanted on ( put "I dont know" if you aren't sure):

Add another pet?

Pet Name:

Pet Species:

Pet Date of Birth/Age:

Is your pet vaccinated for rabies?

Yes
No
I Dont know

Vaccination Date

Who administered your pet’s last rabies vaccination?

The veterinarian issuing my international health certificate
A veterinarian other than the veterinarian issuing my international health certificate

What is the name, address, and phone number of your pet’s previous veterinarian(s)?

You will need to bring the last valid rabies certificate to the appointment.

Does your pet have a microchip:

Yes
No
I Dont know

Microchip Number:

Date It was implanted on ( put "I dont know" if you aren't sure):

Add another pet?

Pet Name:

Pet Species:

Pet Date of Birth/Age:

Is your pet vaccinated for rabies?

Yes
No
I Dont know

Vaccination Date

Who administered your pet’s last rabies vaccination?

The veterinarian issuing my international health certificate
A veterinarian other than the veterinarian issuing my international health certificate

What is the name, address, and phone number of your pet’s previous veterinarian(s)?

You will need to bring the last valid rabies certificate to the appointment.

Does your pet have a microchip:

Yes
No
I Dont know

Microchip Number:

Date It was implanted on ( put "I dont know" if you aren't sure):

TRAVEL INFORMATION

What date is your pet leaving the United States? *

City of Departure: *

What date will your pet arrive at the destination country? *

What is the city and country of arrival destination? *

Will you be travelling to other countries aside from the destination listed above? *

Please list other countries that will be visited by your pet(s) *

How will your pet be traveling? *

List the address and phone number in the destination country where your pet will stay *

Does your destination country require an importation permit? *

Yes
No
I Dont Know

Who is accompanying your pet while traveling? *

The owner
A person authorized by the owner
A pet transport company
No one

Name, Address, Phone Number *

Name, Address, and Phone number of person picking up pet at destination *

How is your pet leaving the United States? *

Air
Car
Train
Boat – Direct
Boat – Stops in other countries

Please list all other countries *

Did your airline, boat, or travel service give you any additional information to be filled out? *

If yes: Please forward this information to info@westsideah.com as soon as possible, at minimum 48 hours before your scheduled appointment time.

Do you have any additional comments to add?

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We proudly serve the pets of Cumberland, Yarmouth, North Yarmouth, Windham, Falmouth, Gray, Gorham, Westbrook, Portland, Auburn, Lewiston, Litchfield, Scarborough, Cape Elizabeth, South Portland, Saco, and the surrounding areas. We look forward to seeing you and your pet. Request an appointment by clicking the button below.

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Questions?

Get in touch! We look forward to hearing from you.

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Location

172 Gray Rd
Cumberland, ME 04021

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Contact Information

Phone: (207) 829-4090
Email: info@westsideah.com

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Hours

Mon-Fri: 8:00 am – 6:00 pm
Sat: 8:00 am – 2:00 pm
Sun: Closed

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