Please read carefully: The information requested below will start the process of your pet(s) Interstate or International Health Certificate for Travel. Please write clearly and provide accurate information. This intake form MUST be submitted 14 days prior to your appointment for Interstate travel or 30 days prior to your appointment for International travel. If your intake form has not been received prior to your pet(s) scheduled appointment it will be canceled.

Please Select Which Location *

(Morningside) North Highland Ave NE
(Midtown) Monroe Dr. NE

Destination *

Departing/ Arrival Date *

Date

Time

Reason for Travel *

Leisure
Relocating
Pet going to new home

Airline with whom you and pet(s) are departing with: *

Airline with whom you and pet(s) are returning with: *

How is pet(s) flying: *

Cabin
Cargo

*Please note that it is the responsibility of the owner to check with the airlines on any specific instructions regarding flying with their pet(s) and relaying that information back to the vet* For more information please check our Travel Service

Name *

First

Last

Phone

Email *

Address

Address Line 1

Address Line 2

City

State

Zip Code

Is the owner listed above flying with the pet(s) *

Yes
No

(If not, please list the full name, address & phone number of person flying with pet(s)

Full Name *

Phone *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

If Pet(s) are being transported to a new recipient at the destination site, please list that individuals Full name, Address & Phone

Full Name

Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

If the pet(s) will be with the same individual they flew with at departure, please list the address where the pet(s) will be staying during that time and phone number if different:

Address

Address Line 1

Address Line 2

City

State

Zip Code

Pet(s) Name *

Owner’s Full Name *

Date

Travel Intake Form

Intake Form for Interstate and International Health Certificate

If Pet(s) are being transported to a new recipient at the destination site, please list that individuals Full name, Address & Phone

If the pet(s) will be with the same individual they flew with at departure, please list the address where the pet(s) will be staying during that time and phone number if different:

Schedule Your Pet’s Visit Today

Intown Animal Hospital Morningside

Intown Animal Hospital Midtown

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