International Pet and Animal Transportation Association

BOAS Pet Owner Questionnaire

 
Record Locator #:
Name of Owner:
Owner Phone contact:
Name of Pet:
Breed:
Age:
Weight:
kg lbs
Microchip #:
Colour:
Male / Female:

Travel Plan

Airline:
Anticipated Date of Travel:
Total Flight duration:
Transit?
Y N
Departure Airport:
Destination Airport:
Transit Airport:
You are requesting to have your dog presented for a Fit-To-Fly Assessment. The assessor is an IPATA certified Veterinary surgeon.
Your dog will undergo a thorough clinical examination, in particular assessing the respiratory function but also looking at other risk factors such as obesity, temperament and any pre-existing significant medical conditions.

Does your dog suffer from any of the following diseases?

Heart or respiratory disease?
No Yes
Epilepsy or seizures?
No Yes
Joint disease?
No Yes
Metabolic diseases such as Diabetes Mellitus, kidney or liver disease, Cancer or other?
No Yes
Any current medications?
No Yes
Has your dog ever failed a Fit-To-Fly Assessment in the past?
No Yes

Travel crate conditioning

Has your dog been acclimated to the travel crate?
No Yes
Does your dog has any pre-existing medical conditions?
No Yes

Snub-nosed Breed Disclaimer

I understand it is my responsibility to ensure that any requirements pertaining to cage or transportation container size (ie. the animal must have sufficient room to stand up, turnaround and lie down without restriction) are met; and I will not hold the IPATA Pet Shipper liable for any losses, costs or expenses related to, or that may arise out of (directly or indirectly) the shipment of the animal.

I have been provided with information in regard to the higher risk of death during flight that is associated with animals that are categorized as brachycephalic breeds (short nosed). These breeds include: English Bulldogs, Pugs, Boston Terriers, Persians, and others. I understand and I accept these risks in full. I will not hold the veterinarian who conducted the BOAS Fit to Fly Assessment responsible for injury/death that may occur with these breeds. I understand the transport of the animal by air has an inherently increased risk of mortality and that environmental conditions (i.e. temperatures and humidity) that may be encountered at origin, place of transit and destination, at time of carriage, can have a significant bearing on the well-being of the Animal/s health. I hereby release and indemnify the Airline, its servants and agents, and the International Pet and Animal Transportation Association, its servants and agents, from and against any and all liabilities, claims, proceedings, costs, losses, damages, charges and expenses which may arise out of, be connected with, or result of death, injury or disability to the animal during transportation.

 

(Signature of Pet Owner)
Date:

 

Full Name of Pet Owner

 

Pet Shipper Details

Name:
IPATA Membership Number:
Email to receive copy:

 

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