Health Certificate Info - Cimarron Animal Hospital

Information needed to fill out Health certificates

* Your pet must be examined within 10 days of traveling. * The Certificate is good for 30 days after it is dated. * We will need an actual destination address to complete your certificate. * We need the following Rabies vaccination information if your pet was vaccinated elsewhere: Vaccination Date, Product Name and serial number of vaccine * Your pet must be healthy, free of external parasites and wounds. Please fill out and submit a separate form for each pet traveling.
Owner's Name*
First Last
Owner's current Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Destination Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Owner's Phone*
How many pets are traveling?*
First Pet's Name*
Species*
- Dog
- Cat
- Ferret
- Other
Microchip Number*

Please provide number or "N/A" if not chipped
Breed*
Age*
Sex*
- Male
- Female
- Spayed/ Neutered
Check all boxes that apply
Color or distinctive markings*
Please bring the your pet's Rabies Vaccination information as indicated below with you to your Visit. If this information is not in your records, please call the vaccinating veterinarian for the information and bring with you. If you have difficulty with this, please let us know as soon as possible! Thank you. Vaccination Date Vaccination Product name/ brand Vaccination serial number