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
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,
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)