Pet Health Certificate Consult Request"*" indicates required fieldsX/TwitterThis field is for validation purposes and should be left unchanged.Pet Name*ImageAccepted file types: jpg, png, Max. file size: 2 GB.Please upload a clear and well-lit photo of your pet for our recordsSpecies*DogCatRabbitBirdReptileOtherBreed*Sex* Female Male Female Spayed Male NeuteredPet's Date of Birth* MM slash DD slash YYYY Pet's Color*Microchip Number*Microchip implant date MM slash DD slash YYYY Owner's Name* First Last Phone*May we text you at that phone number?* Yes NoEmail* Current Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country What is your travel destination?*Is this a permanent move, long term deployment, or a vacation?*What date is your pet departing from Omaha? (Please enter the earliest estimated date if your plans are not yet finalized.)* MM slash DD slash YYYY What date is your pet arriving in the destination country? (Please enter the earliest estimated date if your plans are not yet finalized.)* MM slash DD slash YYYY If traveling for a vacation, when will your pet return to the United States? (Please enter the earliest estimated date if your plans are not yet finalized.) MM slash DD slash YYYY What is the planned flight itinerary? Please provide flight dates and include details of any additional countries that you will visit with your pet. Include details of any additional countries that your pet will "transit" prior to the pet reaching the final destination; this includes plane changes and layovers.*What airline will your pet be traveling with?*Will you and your pet be on the same flight?* Yes NoIf you and your pet will not be on the same flight, please provide YOUR travel details: departure date from USA and arrival date in destination country.Will your pet be flying in the airplane cabin or in the cargo hold?* Cabin CargoWill you be using a pet transport assistance service? If yes, please provide the name of the company and your representative's contact information.*What is the address of your new home or vacation residence in the destination country? Please note that we must have a physical address (street address) for your health certificate. Military APO addresses or PO Box addresses are NOT accepted on health certificates*Date of your pet's most recent rabies vaccination?* MM slash DD slash YYYY Please upload a clear copy of your pet's most recent rabies vaccination certificate. Drop files here or Select filesMax. file size: 2 GB.Date of your pet's prior rabies vaccination? (The vaccination prior to the most recent one.)* MM slash DD slash YYYY Please provide the clinic name and contact information for your pet's current regular veterinarian. We may need to contact that veterinarian if additional medical records are required to facilitate your pet's health certificate and pre-travel requirements.*A non-refundable $50.00 health certificate consultation fee is required in order to review your pet's current medical records and determine what pre-travel vaccinations and/or tests have been completed or still need to be done. After submitting this form, please contact our office at 402-291-1255 to make payment via credit card. If you wish to pay by cash or check, visit our office at 10410 S. 25th Street, Bellevue, NE.We accept American Express, CareCredit, Discover, MasterCard, and Visa.Signature*
