Larchmont Village Vet - International Travel Form & Waiver

Country to which the patient is traveling.*

What is the date of departure?*

mm/dd/yyyy

What is the date of arrival to your destination?*

mm/dd/yyyy (If different from your date of departure)

What is the anticipated duration of your trip?*

# days/weeks/months

YesNo

Name of Owner*

First NameLast Name

YesNo

Name of Individual Traveling with the Pet

First NameLast Name

Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

Email*

example@example.com

Pet Name*

Species*

Breed*

Sex*

Current Address*

Street Address

Street Address Line 2

CityState / Province/Region

Postal / Zip Code

Destination Address*

Street Address

Street Address Line 2

CityState / Province/Region

Postal / Zip Code

Phone number you can be reached at your destination*

Please enter a valid phone number.Format: (000) 000-0000.

Microchip Number*

Date of Implantation*

Provide previous animal hospital to contact for medical records and previous vaccine history PRIOR to visit.*

I have read and understand

Additional Travel Information*

Provide name and contact information of pet travel agency, other destinations if multiple countries are being traveled to, etc.

Client Name*

First NameLast Name

Pet Name*

Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

I understand that Larchmont Village Vet needs at least one month's notice before my flight to accommodate my pet. I understand that it is my responsibility to know the requirements and collect proper documentation for my pet’s travel into a foreign country, which can be found on the USDA website (https://www.aphis.usda.gov/aphis/pet-travel). I also understand that Larchmont Village Vet or its employees are not accountable once the paperwork leaves the hospital. We have no control over issues that may arise while in the possession of the USDA or UPS, such as a delay in shipment.*

I have read and understand

Regulations for animals traveling outside of the United States are governed by the destination Foreign Country. Those regulations and requirements may change at any time and without notice. The requirements and forms may be complex and may not be readily available to us. It is the responsibility of the animal owners to obtain written documentation of the requirements needed from the embassy or consulate of the country of destination and any other countries the pet may need to enter. Vaccination requirements, microchip/identification requirements, rabies titer requirements, prohibited species, and specific treatment requirements are especially important. If proper requirements are not completed according to regulations of the destination country and/or documents are improperly completed, the owner of the animal may be subject to additional costs and the animal may be subject to but not limited to additional treatments, vaccinations, testing, a required quarantine period, or expulsion from the destination country at the owner's expense.*

The costs associated with any additional treatment and/or quarantine, and/or the cost associated with the refusal for the pet to enter the country of destination is the responsibility of the pet owner.

If an error is discovered and the pet is declined entry into the country of destination it is the pet owner’s responsibility to cover the costs of a new health certificate and/or additional treatments, vaccinations, quarantine periods, or testing.

We make no claim of warranty, suitability, or acceptability for the International Health Certificate beyond our endorsement on the forms provided by the owner and/or the USDA APHIS office. We do not guarantee in any way that the form used is the correct form required by the nation or nations at the time of endorsement or at the time of travel. We do not warranty in any way that the pet may not be quarantined upon arrival or undergo any additional testing, treatments, or vaccinations.*

I understand that regulations for the travel and importation of an animal are regulated by the country or countries that animal may visit. I understand that I am ultimately responsible for ensuring that the requirements are completed in a timely manner and the proper forms are created.

Printed Name*

First NameLast Name

Signature*

I agree to hold Larchmont Village Vet and all agents thereof harmless for any errors or omissions or expenses related to requirements and documentation for my pets’ travel.

Date*

Date

Once this form and required documentation is received, one of our staff members will reach out to schedule an appointment.

International Travel Waiver