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Pet's name *

Your First and Last Name

Date of Entry

Phone Number on patient's file

Email*

Tested positive for COVID-19?

Yes

Been tested for COVID-19 and are waiting for results?

Yes

Have any of the following respiratory symptoms? (Fever, Chills, Difficulty Breathing, Sore Throat, Trouble Swallowing, Cough, Shortness of Breath)

Yes

Recently lost or have a decreased sense of smell or taste?

Yes

Have any GI symptoms? Diarrhea? Nausea? Abdominal Pain?

Yes

Been not feeling well, have extreme tiredness or sore muscles?

Yes

Been in contact with someone who has tested positive for COVID-19 ?

Yes

Traveled outside of Canada in the past 14 days?

Yes

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Covid-19 Screening Questionnaire

We are currently working with a CLOSED-DOOR POLICY. One person and your pet(s) will be allowed into the building for appointments with a doctor ONLY. Please call us at 905-846-3316 when you arrive and one of the doctors assistants will bring you in when the doctor is ready for you.

In order for us to be able to stay open for your veterinary needs, it is imperative that you answer the below questions truthfully for the safety of yourself and our staff.

Thank you for your understanding and patience while we work through these difficult times.

Please review the following self-screening criteria: In the last 14 days, have you or anyone in your family (household):