Charleston Equine Clinic

(843) 875-5133

122 Kay Lane, Summerville, SC 29483

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Health Certificate Form

Health Certificate Form

"*" indicates required fields

This form must be filled out in its entirety before health certificate can be issued.


HORSE(S)
*Please only list horses going to the same address and traveling on the same health certificate. If you are filling this form out for multiple owners you can list each horse with the owner’s name next to it. Example: Chance owned by Jane Doe.
*Names must match what is listed on Coggins Test Result.*
Horse Name
Owner's Name
 

Owner/Consignor's Information

Name*
Address*

Recipient/Consignee's Information

*Please list SAME if same as Owner/Consigner
Is Recipient/Consignee's address different from Owner/Consignor's address?*
Address*

Origin of Horse

Address:*

Destination

Address:*

Carrier/Shipper Details

Address:*

Please upload your Coggins if NOT completed by Charleston Equine Clinic

Drop files here or
Max. file size: 256 MB.
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    Office Hours

    Monday – Friday: 8:30am-5:00pm
    Saturday, Sunday: Office Closed
    Available 24 hours, 7 days a week for equine medical emergencies!

    Appointments

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    (843) 875-5133

    122 Kay Lane
    Summerville, SC 29483

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