7001 United States Interstate and International Certificate o

According to t he P aperwork R eduction Act o f 1995, an ag ency ma y not cond uct or sponsor, an d a p erson i s not r equired to r espond to , a c ollection of
information unless it displays a valid OMB control number. The valid OMB control numbers for this information collection are 0579-0036 and 0579-0333.
The ti me r equired to complete t his i nformation col lection i s esti mated t o av erage .25 h ours per r esponse, i ncluding the ti me for rev iewing in structions,
searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.

UNITED STATES DEPARTMENT OF AGRICULTURE
ANIMAL AND PLANT HEALTH INSPECTION SERVICE

UNITED STATES INTERSTATE AND INTERNATIONAL
CERTIFICATE OF HEALTH EXAMINATION
FOR SMALL ANIMALS

WARNING: Anyone who makes
a false, fictitious, or fraudulent
statement on this document, or
uses such document knowing it
to be false, fictitious, or
fraudulent may be subject to a
fine of not more than $10,000 or
imprisonment of not more than 5
years or both (18 U.S.C. 1001).

5. NAME, ADDRESS, AND TELEPHONE NUMBER OF OWNER (CONSIGNOR)

1. TYPE OF ANIMAL SHIPPED (select one only)
Dog

Cat

BREED – COMMON
OR SCIENTIFIC
NAME

OMB APPROVED
0579-0036
0579-0333

2. CERTIFICATE NUMBER - OFFICIAL USE ONLY

Other_________________

Nonhuman Primate

Ferret

Rodent

3. TOTAL NUMBER OF ANIMALS

4. PAGE

6. NAME, ADDRESS, AND TELEPHONE NUMBER OF RECIPIENT AT DESTINATION (CONSIGNEE)

USDA License/or Registration Number (if applicable)
7. ANIMAL IDENTIFICATION
NAME, AND/OR TATTOO NUMBER
OR OTHER IDENTIFICATION

No dog, cat, nonhuman primate, or additional kinds or classes of animals designated by
USDA r egulation sh all be del ivered to any i ntermediate handler or car rier for
transportation i n com merce, u nless acco mpanied by a heal th ce rtificate ex ecuted a nd
issued by a licensed veterinarian (7 U.S.C. 21.43.9; CFR, Subchapter A, Part 2).

8. PERTINENT VACCINATION, TREATMENT, AND TESTING HISTORY

AGE

SEX

COLOR OR
DISTINCTIVE
MARKS OR
MICROCHIP

RABIES VACCINATION
1 YEAR

2 YEARS

Vaccination Date

OTHER VACCINATIONS,
TREATMENT, AND/OR TESTS AND RESULTS

3 YEARS
Product

Date

Product Type and/or Results

(1)
(2)
(3)
(4)
(5)
(6)

9. REMARKS OR ADDITIONAL CERTIFICATION STATEMENTS (WHEN REQUIRED)

VETERINARY CERTIFICATION: I certify that the animals described in box 7 have been examined by me this date, that the
information provided in box 8 is true and accurate to the best of my knowledge, and that the following findings have been made
(“X” applicable statements).
I have verified the presence of the microchip, if a microchip is listed in box 7.
I certify that the animal(s) described above and on continuation sheet(s), if applicable, have been inspected by me on this date and
appear to be free of any infectious or contagious diseases and to the best of my knowledge, exposure thereto, which would endanger the
animal or other animals or would endanger public health.
To my knowledge, the animal(s) described above and on continuation sheet(s) if applicable, originated from an area not quarantined
for rabies and has/have not been exposed to rabies.

ENDORSEMENT FOR INTERNATIONAL EXPORT (IF NEEDED)
PRINTED NAME OF USDA VETERINARIAN

NAME, ADDRESS, AND TELEPHONE NUMBER OF ISSUING VETERINARIAN

LICENSE NUMBER AND STATE

Accredited
Yes
No
If yes, please complete below
NATIONAL ACCREDITATION NUMBER

SIGNATURE OF USDA VETERINARIAN

APHIS Form 7001
(NOV 2010)

Apply USDA Seal or Stamp here

DATE

NOTE: International shipments may require certification by an accredited veterinarian.

SIGNATURE OF ISSUING VETERINARIAN

This certificate is valid for 30 days after issuance

DATE