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    Update Client Information Form

    You may request a health certificate from Mid-Rivers Equine Centre by following the instructions and filling out the form below. Please note that the items marked with an * are required to forward this form. Thank You!
    Owner/Consignor Information
    * First Name:
    * Last Name:
    * Address 1:
    Address 2:
    * City:
    * State:
    * Zip Code:
    * Phone Number:
    * Email Address:
    Origin/Departing Destination
    * Barn/Farm Name:
    Check if same as above:
    * Address 1:
    Address 2:
    * City:
    * State:
    * Zip Code:
    * Phone Number:
    Hauler Information
    * Hauler Information:
    Consignee/Destination(s)
    Please visit the Department of Agriculture to view individual state requirements for legal entry and interstate travel; you may click here or call our office to request information regarding international travel.
    * Purpose of the trip
    * Name of consignee or destination point:
    * Address 1:
    Address 2:
    * City:
    * State:
    * Zip Code:
    * Phone Number:
    Click Here For Additional Destination(s)
    Patient Information
    * Has this horse been seen by Mid-Rivers Equine Centre within the past 30 days?
    Please note that all horses must be listed separately on the Health Certificate with the exception of foals under the age of 6 months that have not yet been weaned; such foals can be listed as “foal by side” and consequently do not require their own coggins test.
    Barn Name:
    * and/or
    Registered Name:
    * Age  
    * Breed:
    * Color:
    * Sex
    Coggins (EIA) Test Information
    Please note that all horses must have a valid EIA or Coggins test for legal interstate travel, again please visit the Department of Agriculture to view individual state requirements.
    * Location
    Please click here to view individual state requirements concerning vaccinations and prior destination(s), then list the necessary information below. Please note that we cannot complete a Health Certificate without all of the required information as it pertains to each destination.
    Vaccination History:
    Prior Destination(s) in the Past 30 Days:
    Additional Horses-Click Here




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