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) :
Will owner be traveling with pet? (required)
Yes
No
Type of Travel (required)
Interstate travel
International travel
How will your pet be traveling? (required)
Air Cargo
Air Cabin
Other
What Airline? (required)

Flight Number (required)

Destination Address (required)
Street Address (required)
City (required)
,
State / Province (required)
Zip / Postal Code (required)
Reason for Travel (required)
Permanent Relocation
Pleasure
Departure Date of Travel (required)

Arrival Date (required)

Pet's Name (required)

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

Microchip Implantation Date (required)

Pet's Age (required)

Last 2 Rabies Vaccination Dates (required)


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