Travel Appointment Questionnaire

Welcome to Yonge & St. Clair Veterinary Hospital!

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Travel Appointment Questionnaire

Client Information

Title: *

Mrs.
Mr.
Ms.
Dr.

Name *

First

Last

Email *

Patient Information

Name *

Birth Date (or age if unknown) *

Sex

Male
Female

Breed *

Colour *

Microchipped? *

Yes
No
Don’t Know

What date were they microchipped? (if known) *

Where were they microchipped? *

Yonge & St. Clair Veterinary Hospital
Another Vet/Breeder/Rescue

Travel Appointment Information

Destination *

Travel Date *

Will you be moving there permanently? *

Are you interested in a mild sedative for the trip? *

Is microchipping required by the country? *

Yes
No
Don’t Know

Is rabies titer testing required by the country? *

Yes
No
Don’t Know

Is deworming required by the country? *

Yes
No
Don’t Know

Most pets traveling from Canada to another country will need an export certificate issued by a licensed veterinarian and endorsed by an official Canadian Food Inspection Agency (CFIA) veterinarian. *

I understand

Does the country require endorsement by the CFIA? *

Yes
No
Don’t Know

If yes, have you made an appointment? (Include date of appt)

If you answered ‘I don’t know’ to any of the above, please call the CFIA Markham Office at 905-513-2850 to confirm what is required for entry. *

I agreed and understand

Client Signature

Signature *

Clear Signature

Date *

Email

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