International Health Certificate Questionnaire

Name: Central Animal Hospital of Stoneham
Address: 109 Central Street, Stoneham, MA, 02180, United States
Telephone: 781-438-6404
Price range: $

Save time during your next appointment. Complete your required forms online from any device at any time before your visit.

Get Started

International Health Certificate Pre-Visit Questionnaire

Please complete this form carefully and submit. Once our veterinarian receives this, we will review the information and determine if we are able to complete the international health certificate in time for your travel.

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

Contact information

Name *

First

Last

Phone *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Email *

Pet Information

Name *

Species *

Breed *

Age/Date of Birth *

Sex *

Male
Female

to the If

Spayed/Neutered? *

List the destination country that you are traveling to with your pet. *

Who is accompanying your pet while traveling? *

The Pet Owner
A person authorized by the owner
Third Choice
A pet transport company
No One

List the address(es) and phone numbers in the destination country where your pet will stay during the visit. *

How will your pet leave the United States? *

Air – Direct Flight
Air – Layover(s) in another country
Car
Train
Boat – Direct
Boat – Cruise Ship

Airline & Flight Number: *

List the country/countries your pet will land in before the destination country: *

List all countries the cruise ship is stopping at: *

What date will your pet leave the United States? *

Is this Travel for a permanent Move? *

Yes
No
I don't Know

Provide the dates that both you and your pet will arrive in the destination country. *

Does your pet have a microchip? *

Yes, I know the implentation date
Yes, but I don’t know when it was implanted.
No
I don’t know

Microchip Implemented On: *

When was your pat’s last rabies vaccination? *

The veterinarian issuing my international health certificate administered my pet’s last rabies vaccination.
A veterinarian other than the veterinarian issuing my international health certificate administered my pets last rabies vaccination.
I don't know
My pet isn’t vaccinated for rabies.

Please specify the date: *

Please list the name and phone numbers of the veterinary clinic(s) your pet has been seen at in the past so that we can contact them for veterinary records. *

Does your destination country require an import permit? *

Yes
No
I don't Know

Did your airline or cruise ship give you any additional travel requirements for your pet? If you are unsure, please reach out to the airline/cruise ship to find out.

Yes, I will give this to the veterinarian issuing my international health certificate
No

Additional comments:

Have a question?

Our team is here to help! Complete the form below to get in touch.
If this is an emergency, please call us directly at 781-438-6404.

Name *

First

Last

Email *

Hidden may Phone

Phone

I consent to receive SMS text messages from Central Animal Hospital of Stoneham. Msg & data rates may apply. Reply STOP to opt-out. *

How can we help you? *

Phone



Contact Info

Phone: 781-438-6404
Email:
info@centralstreetvet.com



Hours

Mon - Fri: 8 am - 6 pm
Sat - Sun: Closed



Location

109 Central Street
Stoneham, MA 02180
Click here for directions.