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22320 Salamo Rd, West Linn, OR 97068

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HEALTH CERTIFICATE INFORMATION FORM

"*" indicates required fields

Name of person accompanying the pet *

First

Last

Phone *

Date of travel? *

Email *

Address shipping from: (Must be an Oregon Address) *

Address Line 1

Address Line 2

City

State

Zip Code

Address of destination *

Address Line 1

Address Line 2

City

State

Zip Code

Phone number for destination *

Can be phone number for person traveling with pet

Pet Information

Number of pets traveling on this health certificate *

One
Two
Three
Four

1st Pet Information

Pet's Name *

Date of Birth *

Microchip number: (if known)

Have we administered your pet's most recent Rabies vaccine? *

Yes
No

If no, provide the name and number of the veterinary hospital that administered the rabies vaccine:

Do you have a copy of the Rabies Certificate? *

Yes
No

Please upload a copy of Rabies Certificate

Drag & Drop Files, Choose Files to Upload

Accepted file types: jpg, png, doc, pdf.

Does your pet have a current Rabies FAVN Titer for travel (for international travel, if required)? *

Yes
No

Please upload a copy of the current Rebies FAVN Titer

Drag & Drop Files, Choose Files to Upload

Accepted file types: jpg, png, doc, pdf.

2nd Pet Information

Pet's Name *

Date of Birth *

Microchip number: (if known)

Have we administered your pet's most recent Rabies vaccine? *

Yes
No

If no, provide the name and number of the veterinary hospital that administered the Rabies vaccine:

Do you have a copy of the Rabies Certificate? *

Yes
No

Please upload a copy of Rabies Certificate

Drag & Drop Files, Choose Files to Upload

Accepted file types: jpg, png, doc, pdf.

Does your pet have a current Rabies FAVN Titer for travel (for international travel, if required)? *

Yes
No

Please upload a copy of the current Rebies FAVN Titer

Drag & Drop Files, Choose Files to Upload

Accepted file types: jpg, png, doc, pdf.

3rd Pet Information

Pet's Name *

Date of Birth *

Microchip number: (if known)

Have we administered your pet's most recent Rabies vaccine? *

Yes
No

If no, provide the name and number of the veterinary hospital that administered the Rabies vaccine:

Do you have a copy of the Rabies Certificate? *

Yes
No

Please upload a copy of Rabies Certificate

Drag & Drop Files, Choose Files to Upload

Accepted file types: jpg, png, doc, pdf.

Does your pet have a current Rabies FAVN Titer for travel (for international travel, if required)? *

Yes
No

Please upload a copy of the current Rebies FAVN Titer

Drag & Drop Files, Choose Files to Upload

Accepted file types: jpg, png, doc, pdf.

4th Pet Information

Pet's Name *

Date of Birth *

Microchip number: (if known)

Have we administered your pet's most recent Rabies vaccine? *

Yes
No

If no, provide the name and number of the veterinary hospital that administered the Rabies vaccine:

Do you have a copy of the Rabies Certificate? *

Yes
No

Please upload a copy of Rabies Certificate

Drag & Drop Files, Choose Files to Upload

Accepted file types: jpg, png, doc, pdf.

Does your pet have a current Rabies FAVN Titer for travel (for international travel, if required)? *

Yes
No

Please upload a copy of the current Rebies FAVN Titer

Drag & Drop Files, Choose Files to Upload

Accepted file types: jpg, png, doc, pdf.

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Anesthesia / Surgery Consent Form

Canine Annual Exam History Form

Dental Care Consent Form

Vomiting Exam Form

Feline Annual Exam History Form

Health Certificate Form

New Client Form

Online Brief Patient History Form

Online Patient History Form

Sedation Consent Form

Telemedicine Request Form

Pet Sitting Consent Form

22320 Salamo Rd
West Linn, OR 97068

Cascade Summit Animal Hospital is a full service animal hospital, providing medical, dental, diagnostic, surgical and holistic services

Hospital Hours

Monday 8:00 am – 5:30pm

Tuesday 8:00 am – 5:30pm

Wednesday 8:00 am – 5:30pm

Thursday 8:00 am – 5:30pm

Friday 8:00 am – 5:30pm

Weekend CLOSED

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