Health Certificate Form

Name of Consignor*
First Last
(Person shipping pet)
Address*
(PO Boxes not valid)

Street Address Address Line 2 City State ZIP Code
County:*
Phone*
Name of Consignee*
(Person receiving or traveling with pet)
First Last
Address*
(PO Boxes not valid)

Street Address Address Line 2 City State ZIP Code
County:*
Phone*
Shipment / Travel Date*
Date Format: DD slash MM slash YYYY
Travel Type*
(Name of airlines / by vehicle / by ship)
Purpose of Travel*
(Personal / Sale of pet / Breeding)
Pet(s) Name
Species*
(Dog / Cat)
Microchip / Tattoo Number
Physical Description of Pet*
(breed, color, markings)
Is this an international trip?
(If so, airport or port that pet will depart from the US?)
Email for certificate to be forwarded to:

6499 W Commercial Park Avenue – Unit #1
Rathdrum, Idaho, 83858

Call/Txt: (208) 687-2200
staff@rathdrumanimalclinic.com

Monday – Friday:
7:30am – 5:30pm

Saturday/Sunday:
Closed

*Closed daily from 12:00pm – 1:00pm