Health Certificate Information Consignor*(Name of person or company dropping off at the airport) First Name: Last Name: Hawaii Address:*(No P.O. Box allowed) Street Address City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Phone:*Email:* Consignee*(Name of person or company picking up at the airport) First Name: Last Name: Mainland Address:*(No P.O. Box allowed. Hotel or military housing addresses are fine) Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific 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's Name:*Dog or Cat:*(Please choose from dropdown)DogCatMale or Female:*(Please choose from dropdown)MaleFemaleNeutered/Spayed or Intact:*(Please choose from dropdown)NeuteredSpayedIntactAge:*Breed:*(if mixed, write predominant breed)Color:*Weight: (lbs)*Microchip Number:Date of last Rabies vaccine and duration (if any):*Please bring 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.Add additional pets?*YesNoPet's Name:*Dog or Cat:*(Please choose from dropdown)DogCatMale or Female:*(Please choose from dropdown)MaleFemaleNeutered/Spayed or Intact:*(Please choose from dropdown)NeuteredSpayedIntactAge:*Breed:*Date of last Rabies vaccine and duration (if any):Microchip Number:*Will your pet be traveling as cargo or in cabin?*CargoCabinWhich Airlines will you be flying?*Alaska AirlinesAmerican AirlinesDelta AirlinesHawaiian AirlinesUnited AirlinesPhoneThis field is for validation purposes and should be left unchanged.
