Interstate Travel Questionnaire

Health Certificate - Interstate Travel Questionnaire

If you are human, leave this field blank.

Your Contact Information

First Name *

Last Name *

Address Line 1 *

Address Line 2 *

Phone *

Email *

Traveling pet's name (one form per pet, please) *

Breed *

Age *

Gender *

Is pet microchipped? *

Please provide microchip number *

Do you have a copy of your pet's current rabies certificates with vaccination expiration date? *

Purpose of travel * Purpose of travel

Mode of travel * Mode of travel

What is your anticipated departure date? *

Is it a one-way trip? *

If no, how long do you anticipate your pet being away? *

What state are you traveling TO? *

Will you be traveling through/stopping in multiple states? *

Which states will you be traveling THROUGH? *

Have you contacted the airline or carrier (boat, train, etc.) to see if they have required supplemental forms that Ohana Pet Hospital will need to complete prior to travel? *

Have you reviewed the carrier's pet travel policies? *

Which airline are you flying? *

Has your pet ever flown before? *

Where have they traveled on the airplane? *

Are you aware of any medical or behavioral issues regarding your pet that we should be aware of? *

Please explain

Do you anticipate that your pet will need some type of travel-anxiety medicine prescribed? *

Do you anticipate that your pet will be traveling as an emotional support pet? *

Have you traveled with this pet in this capacity prior? *

Do you have official documentation from a physician to support this? *

Is your pet traveling with you, alone, or with someone else? *

Please provide contact information of person traveling with or picking up your pet at destination *

Phone of contact person *

Email of contact person *

Address line 1 for contact person *

Address line 2 for contact person *

805.658.7387

Interstate Travel Questionnaire

Your Contact Information

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