Pet Owner Information

Name *

First

Last

Email *

Primary Phone *

Secondary Phone

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Pet Information

Pet's Name *

Species (dog, cat, rabbit, or guinea pig) *

Breed *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet have a microchip? *

Yes
No

What is the microchip number?

Do you have a second pet? *

Yes
No

Pet's Name *

Species (dog, cat, rabbit, or guinea pig) *

Breed *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet have a microchip? *

Yes
No

What is the microchip number?

Do you have a third pet? *

Yes
No

Pet's Name *

Species (dog, cat, rabbit, or guinea pig) *

Breed *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet have a microchip? *

Yes
No

What is the microchip number?

Do you have a fourth pet? *

Yes
No

Pet's Name *

Species (dog, cat, rabbit, or guinea pig) *

Breed *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet have a microchip? *

Yes
No

What is the microchip number?

Do you have a fifth pet? *

Yes
No

Pet's Name *

Species (dog, cat, rabbit, or guinea pig) *

Breed *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Travel Details

Destination Country *

Destination State/Province/Region

Travel Date *

Return Date, if applicable

Method of Travel *

Air
Car
Other

Airline Name

Please specify:

Is this domestic or international travel? *

Domestic
International

Certificate Details & Supporting Documents

Type of Travel Certificate Needed, if Known

Destination Requirements or Required Documents, if Known

Required Deadline for Certificate Completion

Supporting Documents

Drag & Drop Files, Choose Files to Upload You can upload up to 10 files.

Upload any available vaccine records, previous travel documents, or destination requirements.

Health & Vaccine Information

Is your pet up to date on vaccines? *

Yes
No

Date of most recent rabies vaccine, if applicable

Has your pet been seen by Gardenbrooke Veterinary Hospital before? *

Yes
No

Any current medications or health concerns? *

Yes
No

Please mention the details:

Acknowledgment

I understand travel requirements vary by destination and that submitting this form does not guarantee certificate approval. Gardenbrooke Veterinary Hospital will review my request and contact me with next steps. *

I have read and agree to the above statement.

Travel Certificates Form

Travel Certificate Request

Pet Owner Information

Pet Information

Travel Details

Certificate Details & Supporting Documents

Health & Vaccine Information

Acknowledgment

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Location

Contact Information

Hours

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