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Health Certificate Questionnaire
Are you currently a client with us?
*
Yes
No
First name:
*
Last name:
*
Current Physical Address (not a PO Box):
*
City:
*
State:
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
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Kentucky
Louisiana
Maine
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Mississippi
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Nevada
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Rhode Island
South Carolina
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Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
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Zip Code:
*
Phone Number:
*
Email address:
*
Pet’s name (if more than one, fill out a second form):
*
Age:
*
Canine/Feline/Other:
*
Canine
Feline
Other
Breed:
*
Color:
*
Markings:
*
Male/Female:
*
Male
Female
Spayed or neutered?
Spayed
Neutered
Microchipped:
Yes
No
If yes, microchip number:
Date of last 2 rabies vaccines:
Date of First rabies vaccine:
*
MM slash DD slash YYYY
Date of Second rabies vaccine:
*
MM slash DD slash YYYY
Contact information for the veterinarian that provided the last 2 rabies vaccines (if not PetVet):
*
Dates of travel:
*
MM slash DD slash YYYY
Destination (Country):
*
Airline:
*
Complete physical address of destination:
*
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PetVet Animal Health Center
Home
About
Our Team
Fear Free Certified
Community Involvement
Back
FAQ
Services
Wellness Care
Vaccinations
Dental Care
Surgery
Spay And Neuter
Diagnostics
Boarding
Dermatology
After Hours Emergency Care
Back
Resources
Request an Appointment
Boarding Reservation Request
Prescription Refill Request
Traveling with your Pet
Forms
Pet Health Library
Payment Options
Online Pharmacy
Back
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