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)
Address (required)
Street Address (required)
City (required)
,
State / Province (required)
Zip / Postal Code (required)
Phone (required)
Phone TypePhone Number (required)
E-Mail Address (required) :
Selection (required)
Interstate travel
International travel
Destination Address (required)

Date of Travel (required)

Pet's Name (required)

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

Pet's Age (required)

Last Rabies Vaccination Date (required)


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