Southeast Alabama Veterinary Hospital

540 Westgate Parkway
Dothan, AL 36303

(334)671-1990

www.southeastalabamavet.com

Health Certificate-Pre Departure

Name (required)
First Name (required)
Last Name (required)
Home Address (required)
Street Address (required)
City (required)
,
State / Province (required)
Zip / Postal Code (required)
Phone (required)
Phone TypePhone Number (required)
E-Mail Address (required) :
Type of Travel (required)
Interstate travel
International travel
How will your pet be traveling? (required)
Air Cargo
Air Cabin
Other
What Airline? (required)

Destination Address (required)
Street Address (required)
City (required)
,
State / Province (required)
Zip / Postal Code (required)
Date of Travel (required)

Pet's Name (required)

Is your pet microchipped?
If yes, please provide number- This will be verified at visit (required)

Pet's Age (required)

Last Rabies Vaccination Date (required)


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