Health Certificate Information

Please fill out one form per pet.

Pet Owner

Name*

(No P.O. Box allowed)*

Street Address
City
State
Zip Code
Email
Phone

Consignor:
(Name of person or company dropping off at the airport)

Name*

(No P.O. Box allowed)*

Street Address
City
State
Zip Code
Email
Phone

Mainland Destination Address

Consignee
(Name of person or company picking up at the airport)*

Destination/Mainland Address
(No P.O. Box allowed. Hotel or military housing addresses are fine)*

Street Address
City
State
Zip Code
Email
Phone

Pet Carrier Transport Company

(only if using a pet transporter)

Name of Company
Address
Email
Phone

Departure Date:

Date*

Returning Date:

Only if returning to Hawaii

If you will be returning to Hawaii within 10 days using the same Health Certificate, we will need to administer an approved Flea and Tick prevention during the exam. We will also need current Rabies vaccine information and current FAVN Rabies Titer results.

Date of last Rabies vaccine and duration (if any):

Please bring your pet's Rabies vaccine certificate to the exam since this information will be needed for the Health Certificate unless we are giving a Rabies vaccine at the appointment.

Pet #1:

Pet Name:*

Species:*

Cat

Dog

Breed / Dominant Breed:

(Mixed breed is not accepted as a breed on the travel documents; you must indicate the most dominant breed. Terrier breeds must specify the type of Terrier)
*

Color:*

Sex:*

Female Intact

Female Spayed

Male Intact

Male Neutered

Age:*

Weight:*

Microchip Number:

(we will scan your pet to verify microchip at the appointment)

Will your pet be traveling as cargo or in the cabin?*

Cargo

Cabin

Which Airline(s) will you be flying?

(note only one airline name can be used)
*

Alaska Airlines

American Airlines

Delta Airlines

Hawaiian Airlines

United Airlines

Other

Pet #2:

Pet Name:

Species

Cat

Dog

Breed / Dominant Breed:

(Mixed breed is not accepted as a breed on the travel documents; you must indicate the most dominant breed. Terrier breeds must specify the type of Terrier)

Color

Sex

Female Intact

Female Spayed

Male Intact

Male Neutered

Age

Weight

Microchip Number:

(we will scan your pet to verify microchip at the appointment)

Will your pet be traveling as cargo or in the cabin?

Cargo

Cabin

Which Airline(s) will you be flying?

(note only one airline name can be used)

Alaska Airlines

American Airlines

Delta Airlines

Hawaiian Airlines

United Airlines

Other

Pet #3:

Pet Name:

Species

Cat

Dog

Breed / Dominant Breed:

(Mixed breed is not accepted as a breed on the travel documents; you must indicate the most dominant breed. Terrier breeds must specify the type of Terrier)

Color

Sex

Female Intact

Female Spayed

Male Intact

Male Neutered

Age

Weight

Microchip Number:

(we will scan your pet to verify microchip at the appointment)

Will your pet be traveling as cargo or in the cabin?

Cargo

Cabin

Which Airline(s) will you be flying?

(note only one airline name can be used)

Alaska Airlines

American Airlines

Delta Airlines

Hawaiian Airlines

United Airlines

Other

Pet #4:

Pet Name:

Species

Cat

Dog

Breed / Dominant Breed:

(Mixed breed is not accepted as a breed on the travel documents; you must indicate the most dominant breed. Terrier breeds must specify the type of Terrier)

Color

Sex

Female Intact

Female Spayed

Male Intact

Male Neutered

Age

Weight

Microchip Number:

(we will scan your pet to verify microchip at the appointment)

Will your pet be traveling as cargo or in the cabin?

Cargo

Cabin

Which Airline(s) will you be flying?

(note only one airline name can be used)

Alaska Airlines

American Airlines

Delta Airlines

Hawaiian Airlines

United Airlines

Other

Health Certificate Information

Pet Owner

Name*

(No P.O. Box allowed)*

Consignor: (Name of person or company dropping off at the airport)

Name*

(No P.O. Box allowed)*

Mainland Destination Address

Consignee (Name of person or company picking up at the airport)*

Destination/Mainland Address (No P.O. Box allowed. Hotel or military housing addresses are fine)*

Pet Carrier Transport Company

(only if using a pet transporter)

Departure Date:

Date*

Returning Date:

Only if returning to Hawaii If you will be returning to Hawaii within 10 days using the same Health Certificate, we will need to administer an approved Flea and Tick prevention during the exam. We will also need current Rabies vaccine information and current FAVN Rabies Titer results.

Date of last Rabies vaccine and duration (if any):

Please bring your pet's Rabies vaccine certificate to the exam since this information will be needed for the Health Certificate unless we are giving a Rabies vaccine at the appointment.

Pet #1:

Pet Name:*

Species:*

Breed / Dominant Breed: (Mixed breed is not accepted as a breed on the travel documents; you must indicate the most dominant breed. Terrier breeds must specify the type of Terrier)*

Color:*

Sex:*

Age:*

Weight:*

Microchip Number: (we will scan your pet to verify microchip at the appointment)

Will your pet be traveling as cargo or in the cabin?*

Which Airline(s) will you be flying? (note only one airline name can be used)*

Pet #2:

Pet Name:

Species

Breed / Dominant Breed: (Mixed breed is not accepted as a breed on the travel documents; you must indicate the most dominant breed. Terrier breeds must specify the type of Terrier)

Color

Sex

Age

Weight

Microchip Number: (we will scan your pet to verify microchip at the appointment)

Will your pet be traveling as cargo or in the cabin?

Which Airline(s) will you be flying? (note only one airline name can be used)

Pet #3:

Pet Name:

Species

Breed / Dominant Breed: (Mixed breed is not accepted as a breed on the travel documents; you must indicate the most dominant breed. Terrier breeds must specify the type of Terrier)

Color

Sex

Age

Weight

Microchip Number: (we will scan your pet to verify microchip at the appointment)

Will your pet be traveling as cargo or in the cabin?

Which Airline(s) will you be flying? (note only one airline name can be used)

Pet #4:

Pet Name:

Species

Breed / Dominant Breed: (Mixed breed is not accepted as a breed on the travel documents; you must indicate the most dominant breed. Terrier breeds must specify the type of Terrier)

Color

Sex

Age

Weight

Microchip Number: (we will scan your pet to verify microchip at the appointment)

Will your pet be traveling as cargo or in the cabin?

Which Airline(s) will you be flying? (note only one airline name can be used)

Consignor:
(Name of person or company dropping off at the airport)

Consignee
(Name of person or company picking up at the airport)*

Destination/Mainland Address
(No P.O. Box allowed. Hotel or military housing addresses are fine)*

Only if returning to Hawaii

If you will be returning to Hawaii within 10 days using the same Health Certificate, we will need to administer an approved Flea and Tick prevention during the exam. We will also need current Rabies vaccine information and current FAVN Rabies Titer results.

Breed / Dominant Breed:

(Mixed breed is not accepted as a breed on the travel documents; you must indicate the most dominant breed. Terrier breeds must specify the type of Terrier)
*

Microchip Number:

(we will scan your pet to verify microchip at the appointment)

Which Airline(s) will you be flying?

(note only one airline name can be used)
*

Breed / Dominant Breed:

(Mixed breed is not accepted as a breed on the travel documents; you must indicate the most dominant breed. Terrier breeds must specify the type of Terrier)

Microchip Number:

(we will scan your pet to verify microchip at the appointment)

Which Airline(s) will you be flying?

(note only one airline name can be used)

Breed / Dominant Breed:

(Mixed breed is not accepted as a breed on the travel documents; you must indicate the most dominant breed. Terrier breeds must specify the type of Terrier)

Microchip Number:

(we will scan your pet to verify microchip at the appointment)

Which Airline(s) will you be flying?

(note only one airline name can be used)

Breed / Dominant Breed:

(Mixed breed is not accepted as a breed on the travel documents; you must indicate the most dominant breed. Terrier breeds must specify the type of Terrier)

Microchip Number:

(we will scan your pet to verify microchip at the appointment)

Which Airline(s) will you be flying?

(note only one airline name can be used)