APHIS Form 7001: United States Interstate and International Certificate of Health 

 Examination for Small Animals 



TYPE OF ANIMAL SHIPPED [block 1] 



On this form, you may mix animals of different species. 

 Check all species that apply to the current shipment. 



CERTIFICATE NUMBER 



Again, this number is preprinted on the official APHIS 

 Form 7001. We have erased the form number for secu- 

 rity reasons. 



TOTAL NUMBER OF ANIMALS [block 2] 



Self-explanatory. The PAGE block directly to the right 

 of block 2 (and itself unnumbered) refers to "Page 1 of 

 X" where X indicates the continuation sheets (APHIS 

 Form 7001 A) that are attached with this Form 7001. 



NAME, ADDRESS AND TELEPHONE NUMBER OF 

 OWNER/CONSIGNOR [block 3] 



Self-explanatory. If the consignor is licensed or regis- 

 tered under the Animal Welfare Act, include his or her 

 official USDA number. Insert his or her telephone num- 

 ber regardless of registration status. 



NAME, ADDRESS AND TELEPHONE NUMBER OF 

 CONSIGNEE [block 4] 



Insert the shipper's information here, including USDA 

 license or registration number (if applicable) and 

 phone number. 



ANIMAL IDENTIFICATION [block 5, lines 1-10 

 as needed] 



The owner or consignor (shipper) fills in ihi^ infi^rma- 

 tion. The owner or consignor also checks with an X 

 both certification in the unnumbered block below line 

 10 of block 5 and signs and dates the form below those 

 check-marked blocks. 



VACCINATION HISTORY [block 6] 



You till ill this section. It rabies certificates are in\ol\cd, 

 attach them (showing your original signature, not a 

 photocopy) at the black arrow on the right-hand side 

 ot the form. 



VETERINARY CERTIFICATION [unnumbered block 

 below block 6] 



Check the block(s) that apph. Print your name, 

 address and telephone number in the block provided 

 and insert your license number and the name of the 

 State where you received it. Finally, sign at the bottom 

 right and insert the date you examined the animals on 

 this certificate. 



ENDORSEMENT FOR INTERNATIONAL EXPORT 

 [unnumbered block at the lower left corner of 

 the form] 



If the animals on this shipment arc being sent out of 

 the United States, a USDA veterinarian must apply the 

 USDA seal or stamp and sign and date this Form 7001 . 



16-42 



