Welcome! Please complete for your health certificate. Client Name * First Name Last Name Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Email * Phone * (###) ### #### Patient Name Barn Name Sex Gelding Mare Stallion Filly Colt Age Breed Color Markings Please be descriptive (sock, blaze, star etc) Hauler Name Hauler Physical Address Address 1 Address 2 City State/Province Zip/Postal Code Country Hauler Phone Number Hauler Email Address Destination Address Address 1 Address 2 City State/Province Zip/Postal Code Country Destination Phone (###) ### #### Haul Date MM DD YYYY Thank you for completing the Health Certificate information. We will be in touch soon.