Request a Health Certificate at Countryside Vets

Request an Equine

Health Certificate

Fields marked with an * are required.

owner information

Name*

Are you a Countryside Client?*

Yes

Email Address*

Phone Number*

Street Address*

City*

State*Zip Code*

destination

Consignee/Recipient*

Facility*

Street Address*

City *

State*Zip Code*

Phone Number*

Email Address

Movement

Horse's Origin *
(Where horse departs from)

Street Address*

City*

State*Zip Code*

Phone Number*

Email Address

Reason for Movement*

Shipping Date

Who will be shipping?*

Shipper's Name*

Shipper's Street Address

City

StateZip Code

Shipper's Phone Number

Shipper's Email Address

Horse INformation

Horses' Name*

Horse Inspection Requirement*
If we have not seen the horse in the last 30 days, we will need to perform a physical exam to ensure the horse is in good health.

Inspection Date

Need Appointment

We MUST have a current Coggins. *
If Coggins was not processed through us, we will need a clear, and full image copy of your current Coggins.

Upload Coggins

Choose File

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You have my Coggins

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Online Patient Forms

Health Certificate

Phone

Email

Hours