Pet Travel Health Certificate

Certificate No.
Date of Issue

Owner Information

Owner Name
Address
Phone
Email

Pet Information

Pet Name
Species
Breed
Age
Sex
Color/Markings
Identification (Microchip/Tag)

Vaccination & Health Information

Vaccinations
Health Status
Medical Treatments/Notes

Veterinarian Certification

Date of Examination
Place of Examination
Veterinarian's Signature
Owner's Signature