Owner's Name: *

First Name

Last Name

Phone Number *

Country

(###)

###

####

Departure Date *

Date you plan to leave the US.

MM

DD

YYYY

Arrival Date

Date you plan to arrive at your destination country.

MM

DD

YYYY

Return Date

If you are planning to return to the US with your pet, what date will this occur?

MM

DD

YYYY

Acknowledgement *

By checking the box labeled "I understand.", I am acknowledging my understanding of the following: 1. Sage Veterinary Center (SVC) is a USDA-accredited veterinarian whose accreditation allows them to certify pets' health for international travel. The requirements SVC must uphold for each destination can be found here: https://www.aphis.usda.gov/pet-travel/us-to-another-country-export. 2. SVC is NOT a travel company - i.e., they are not responsible for the physical transportation of my pet. 3. SVC recommends, generally, that international travel begin to be planned at least 2 months (for some destinations, it may take longer - sometimes over 1 year to prepare) before the pet(s)'s scheduled departure; any failure to plan/discuss this travel with SVC within this suggested timeframe is my responsibility and may result in my pet being uncertifiable for travel and/or a significant delay in my travel plans. 4. If my pet is scheduled with SVC for a travel appointment, SVC will complete the necessary USDA paperwork and submit it for endorsement to the USDA on my behalf. 5. Once my pet(s)'s documentation has been submitted to the USDA, it is the responsibility of the USDA to return the documents to me before my departure. SVC has no control over the length of time, responsiveness, or endorsement decisions of the US Government. 6. Any failure to complete this form accurately or in a timely fashion may delay SVC's ability to assist me in preparing my pet for travel, which may prevent my pet from being able to travel abroad. 7. No travel appointments will be scheduled for new clients/patients who do not have complete medical records on file with SVC. 8. Any failure to provide complete and up-to-date medical records may result in my pet being uncertifiable for travel and/or additional expenses for the travel preparation, which are my sole responsibility. 9. Only Applies to Canines: If planning to return to the US with my dog, I understand that there are likely additional CDC requirements for my pet to re-enter the US. SVC can assist me with this additional paperwork if it applies to my pet(s)'s travel for additional fees. More information can be found here: https://www.cdc.gov/importation/dogs/index.html.

I understand.