At a glance
Foreign veterinarians must complete this document for each dog traveling to the U.S. from a high-risk country. This is the only government-endorsed form required for foreign vaccinated dogs coming from a high-risk country. This form is valid for entry for 30 days from the date of issuance listed in Section F. All responses on the form must be typed.
Section A: Owner or Consigner Contact Information
- Enter the full name of the owner or consigner.
- Enter the physical address of the owner or consignor.
- Enter the direct dial phone number (including extension if applicable) of the owner or consignor.
- Enter the email address of the owner or consignor.
Section B: Owner or Consignee Contact Information
Important:
- If all information in Section A is the same as section B:
- Check the box "Select if information is same as section A."
- Leave section B blank and move to Section C of the form.
- Check the box "Select if information is same as section A."
- If any information in Section B is different from the information in Section A, complete section B:
- Enter the full name of the recipient of the dog.
- Enter the physical address (no PO Boxes) of where the dog will be housed in the United States.
- Enter the direct dial phone number (including extension if applicable) of the recipient of the dog.
- Enter the email address of the recipient of the dog (consignee).
- Enter the full name of the recipient of the dog.
Section C: Animal Identification
- Enter the animal's name.
- Enter the microchip and the date the microchip was implanted. If the implant date is unknown, input earliest date when the microchip is documented on the dog's medical/vaccination records. The microchip must be readable by a universal microchip scanner, and the microchip must have been implanted before the rabies vaccination was administered.
- Enter the dog's breed and sex (gender).
- Enter the dog's date of birth using the mm/dd/yyyyA format or age if the date of birth is unknown.
- Enter the dog's color or note any distinguishable markings on the dog.
Note:
Section D: Rabies Vaccine Information
The veterinarian must document at a minimum a current rabies vaccination. The microchip must have been implanted before the rabies vaccine was administered or the vaccine will be invalid. If the importer is presenting a valid rabies serology titer (so the dog does not need to undergo a 28-day quarantine after arrival), the veterinarian must also document a rabies vaccination administered at least 30 days before the serology was drawn, and all rabies vaccinations administered after the dog's rabies serology was drawn, to prove that vaccination coverage has not lapsed. If there is insufficient space on the Certification of Foreign Rabies Vaccination and Microchip form, additional copies of Certification of Foreign Rabies Vaccination and Microchip form should be used.
Section E: Rabies Serology Information (if available)
Rabies serology results from a CDC-approved laboratory, if available, must be submitted with this form for certification by the official government veterinarian.
- If the owner or consignor provides rabies serology results:
- Enter the laboratory name and country where the lab is located.
- Confirm the results from a CDC-approved laboratory. If the serology results are not from a CDC-approved laboratory, check the box "select if no serology results are included with this form."
- Enter the date the sample was collected using the mm/dd/yyyyA format.
- Enter the date the sample was tested using the mm/dd/yyyyA format.
- Enter the result reported by the laboratory including units.
- Enter the laboratory name and country where the lab is located.
- If the owner or consignor did not provide rabies serology results for review:
- Check box "select if no serology results are included with this form."
- Check box "select if no serology results are included with this form."
Note:
Section F: Examining Veterinarian Certification Statement and Signature
Note:
This form MUST be completed and signed by the veterinarian who examined the dog. The examining veterinarian must be authorized by the competent authority to practice veterinary medicine in the exporting country or be an official government veterinarian.
- Read and verify Section F, statement 1-9.
- Select the appropriate bullet for statement 6 based on the dog's vaccination records.
- Select the appropriate bullet for statement 6 based on the dog's vaccination records.
- Type your name and title (e.g., associate veterinarian, etc.).
- Type the physical street address including city, region/state, and country of the veterinary clinic or hospital where you work.
- Type the veterinary business' telephone number.
- Type the veterinary business' email address.
- Type the license number of the examining veterinarian.
- Type the date of examination when this form was completed use the mm/dd/yyyyA format.
- Electronically sign the form using an authenticated digital signature (e.g., DocuSign).
- Wet signatures are acceptable in the "veterinarian's signature" block if the document cannot be signed electronically; however, sections A-F must be typed.
- Wet signatures are acceptable in the "veterinarian's signature" block if the document cannot be signed electronically; however, sections A-F must be typed.
- Submit the form and all accompanying documentation to the exporting country's official government veterinarian for review and certification.
Section G: Endorsement by Official Government Veterinarian in Exporting Country
- Verify the animal’s name and microchip listed on page 2 match the information listed on page 1 of this form.
- If available, review the attached rabies serology results and certify the serology results are: (1) from a CDC-approved laboratory; and (2) greater than or equal to 0.5 IU/mL.
- Read and verify Section G, statements 1-4.
- Print your name and title.
- Enter your physical street address including city, region/state, and country.
- Enter your email address (government email address preferred).
- Enter the date you reviewed and certified the information using the mm/dd/yyyyA format.
- Electronically sign the form using an authenticated digital signature (e.g., DocuSign).
- Wet signatures (non-electronic signatures hand-written with a pen) are acceptable in the "official government veterinarian's signature" block if the document cannot be signed electronically. An official wet seal must be affixed to all forms with wet signatures.
- Wet signatures (non-electronic signatures hand-written with a pen) are acceptable in the "official government veterinarian's signature" block if the document cannot be signed electronically. An official wet seal must be affixed to all forms with wet signatures.
- Affix the government seal electronically or apply a wet seal in the space provided.
- Enter your email address ( government email address preferred).
- Failure to input the date using the correct mm/dd/yyyy format is grounds for the dog to be denied entry into the United States and returned to the country of departure at the owner or importer’s expense.