COVID-19 Screening Questionnaire

Client Name*
First Last
Client Contact Number*
Pet Name*
Do you have any of the following new or worsening symptoms or signs? Symptoms should not be chronic or related to other known causes or conditions.*
 Fever or chills  Difficulty breathing or shortness of breath  Cough  Sore throat, trouble swallowing  Runny nose/stuffy nose or nasal congestion  Decrease or loss of smell or taste  Nausea, vomiting, diarrhea, abdominal pain  Not feeling well, extreme tiredness, sore muscles
Have you travelled outside of Canada in the past 14 days?*
Have you had close contact with a confirmed or probable case of COVID-19?*
Results of Screening Questions:
- If you have answered NO to all questions, then you have passed and can enter the practice for your scheduled appointment.
- If you answered YES to any question, then we can keep your appointment as scheduled and will see your pet(s) for a curbside appointment.

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