Fillable Printable United States Interstate And International Certificate of Health Examination for Small Animals
Fillable Printable United States Interstate And International Certificate of Health Examination for Small Animals
United States Interstate And International Certificate of Health Examination for Small Animals
NVAP Module 2: Role of Agencies, Health Certicates
October 2010 • Page 1 of 1
This information was developed by sta
veterinarians at the CFSPH and approved
by APHIS for use as training materials for
the USDA APHIS National Veterinary
Accreditation Program.
The APHIS Form 7001 is intended to provide a readily recognized health certicate to be used primarily for international
transportation of pet animals as well as interstate shipments to Hawaii or Alaska. The form is also used as a health certi-
cate for licensees and registrants under the Animal Welfare Act (see Code of Federal Regulations, 9 CFR 2.1-2.30).
Not all countries accept this document; some countries require their own bilingual health certicate, and some foreign coun-
tries require both documents. Therefore, for international travel, consult the National Center for Import/Export International
Regulations website at http://www.aphis.usda.gov/regulations/vs/iregs/animals/ and call your VS Area Ofce to determine the
proper documentation required.
This document is intended to provide guidance on how to complete APHIS Form 7001 and APHIS Form 7001A, the continu-
ation sheet. Recognize that these are not ofcial directions and forms change over time. If you have any questions regarding
how to complete this form, contact your VS Area Ofce for ofcial guidance. A properly completed form is critical to assure
proper compliance.
1. TYPE OF ANIMAL SHIPPED: Mark the appropriate box. Mark only one animal type per health certicate. More than
one animal of the same animal type can be listed on the certicate.
CERTIFICATE NUMBER: Each APHIS Form 7001 has a unique preprinted document number as do many other VS forms.
If a continuation sheet (APHIS Form 7001A) is needed, put this preprinted number on every continuation sheet.
2. TOTAL NUMBER OF ANIMALS: Total number of animals listed on this health certicate.
PAGE: Show the total number of pages for the shipment on each page. Example: if only the APHIS Form 7001 is used, Page
1 of 1 would be entered here; if two APHIS Form 7001A continuation sheets were used, Page 1 of 3 would be entered here
and the two continuation sheets would be numbered: “Page 2 of 3” and Page 3 of 3”.
3. NAME, ADDRESS AND TELEPHONE NUMBER OF OWNER/CONSIGNOR: Name, address, city, state, zip
code, and telephone number (including area code) of owner or consignor. Provide the USDA license or registration
number of the owner/consignor if applicable. The owner may or may not be the consignor.
4. NAME, ADDRESS AND TELEPHONE NUMBER OF CONSIGNEE: Name, address, city, state, zip code, country
(if outside the U.S.), and telephone number (including area code) of the consignee. Provide the USDA license or
registration number of the consignee if applicable.
5. ANIMAL IDENTIFICATION: To be completed by owner/consignor.
Complete one line for each animal, although if the unique identication or distinctive marks need additional space,
succeeding lines may be used. If that is necessary, then the line numbers on the left need to be adjusted to reect the
animals listed on the form.
COMPLETE USDA TAG COLLAR AND/OR TATTOO NUMBER: Provide a unique identication number for each
animal here. If microchips are being used, indicate that number here.
BREED – COMMON OR SCIENTIFIC NAME: Provide the breed of the animal here. For animals with no breed
name (nonhuman primates or other), indicate common or scientic name.
AGE: Indicate age and units, by years, months, weeks, or days. Example: 3y, 8m, 12w, or 5d.
SEX: Indicate the sex of the animal (M – Male, F – Female, NM – Neutered Male, NF –Neutered Female).
COLOR OR DISTINCTIVE MARKS: Provide the color of the animal and/or any distinctive marks.
APHIS Form 7001 United States Interstate and International
Certicate of Health Examination for Small Animals
(Aug 2001 Version)
NVAP Module 2: Role of Agencies, Health Certicates
October 2010 • Page 2 of 2
“X” APPLICABLE STATEMENTS: The Owner/Consignor Certication box should be marked certifying that the animals
listed in the Animal Identication section are true and correct and that the individual identifying said animals has physical
and legal custody of such animals.
NOTE: The 2010 issue of the form does not have the acclimation certication. If the animal needs to have an ac-
climation certication made for the shipment, mark the box of “acclimated to air temperatures lower than 7.2º C”.
If the acclimation certication needs to be made and the form does not have the certication, the owner should print
the certication on the form and initial the certication. USDA released a new APHIS Form 7001 in November
2010. It is available online as a llable form at http://www.aphis.usda.gov/library/forms/pdf/APHIS7001.pdf.
NOTE: Box numbers have changed so read carefully and complete accordingly.
SIGNATURE: Signature of owner or consignor.
DATE: Date the form is signed by the owner or consignor.
6. VACCINATION HISTORY: To be completed by veterinarian.
**Attach a Rabies certicate with an original signature to this document.
RABIES: Mark type of rabies vaccine administered (Killed or Live).
DATE: Indicate the date that the vaccine was administered.
PRODUCT: Indicate the name of the product or manufacturer of the rabies vaccine administered.
D-H-L: Indicate the date and product name of the distemper, hepatitis, and leptospirosis vaccination if administered.
OTHER VACCINATIONS, TESTS OR TREATMENTS: Indicate any additional vaccinations administered or tests and
treatments performed.
DATE: Indicate the date that vaccination(s), test(s), or treatment(s) were administered.
TYPE/RESULT: Indicate any procedures performed and appropriate test results. Examples: Parvo Vacc,
Bruc Test/Neg.
VETERINARY CERTIFICATION: Mark with an “X” all appropriate statements.
NAME, ADDRESS AND TELEPHONE NUMBER: Name, mailing address, and telephone number (including area code)
of the certifying veterinarian.
LICENSE NO.: State license number of the certifying veterinarian. Check the appropriate box regarding accreditation status.
LICENSING STATE: Enter the state in which the veterinary license number posted in the above box was issued.
SIGNATURE: Signature of the certifying veterinarian. The National Accreditation Number (NAN) should be added after the
signature if required.
DATE: Date the document was signed by the certifying veterinarian.
ENDORSEMENT FOR INTERNATIONAL EXPORT: This section is to be lled out by the proper USDA veterinarian
(usually the Area Veterinarian-in-Charge).
APHIS Form 7001 United States Interstate and International Certicate of Health
Examination for Small Animals (Aug 2001 Version) (cont’d)
