Coggins and Health Certificate Form

This completed form is required by law in order for us to provide service. This information is kept secure, private and will not be shared with any 3rd party without your expressed consent.
  • MM slash DD slash YYYY
  • Agent Information

    If you indicate yes, please complete the following sections. Otherwise please skip to the owner section.
  • Owner Information

  • Horse Information

  • Examples include star, right hind sock, left hind pastern (white), brand description, etc.
  • MM slash DD slash YYYY
  • Max. file size: 256 MB.
    Front/face photo must show from muzzle to ears while side photos must show nose to tail, back to hooves.
  • NameBreedSexAgeColorMarkings 
  • Destination Information for Health Certificate or "CVI"

  • MM slash DD slash YYYY
  • Must have physical address. If show grounds, the city, state and name of show grounds is adequate.
  • This field is for validation purposes and should be left unchanged.