Health Certificate Information

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

(No P.O. Box allowed)*

Street Address
City
State
Zip Code

Phone Number:*

Email:*

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

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

Street Address
City
State
Zip Code

Phone:*

Email:*

Departure Date:
*If you are unsure, this can be left blank, but the Health Certificate is only valid for 10 days. Another appointment will be needed if you do not fly out and arrive at your destination within 10 days.

Returning Date:
*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.

Pet Name:*

Species:*

Cat

Dog

Breed:*

Color:*

Sex:*

Female Intact

Female Spayed

Male Intact

Male Neutered

Age:*

Weight:*

Microchip Number:

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.

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

Cargo

Cabin

Which Airline(s) will you be flying?*

Alaska Airlines

American Airlines

Delta Airlines

Hawaiian Airlines

United Airlines

Other

Health Certificate Information

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

Hawaii Address

(No P.O. Box allowed)*

Phone Number:*

Email:*

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

Mainland Destination Address

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

Phone:*

Email:*

Departure Date:
*If you are unsure, this can be left blank, but the Health Certificate is only valid for 10 days. Another appointment will be needed if you do not fly out and arrive at your destination within 10 days.

Returning Date:
*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.

Pet Information:

Pet Name:*

Species:*

Breed:*

Color:*

Sex:*

Age:*

Weight:*

Microchip Number:

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.

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

Which Airline(s) will you be flying?*

Health Certificate Information

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

Hawaii Address

(No P.O. Box allowed)*

Phone Number:*

Email:*

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

Mainland Destination Address

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

Phone:*

Email:*

Departure Date: *If you are unsure, this can be left blank, but the Health Certificate is only valid for 10 days. Another appointment will be needed if you do not fly out and arrive at your destination within 10 days.

Returning Date: *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.

Pet Information:

Pet Name:*

Species:*

Breed:*

Color:*

Sex:*

Age:*

Weight:*

Microchip Number:

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.

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

Which Airline(s) will you be flying?*

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

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

Departure Date:
*If you are unsure, this can be left blank, but the Health Certificate is only valid for 10 days. Another appointment will be needed if you do not fly out and arrive at your destination within 10 days.

Returning Date:
*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.