COVID Intake Form

We have adopted a screening protocol for our appointment bookings. Depending upon a client’s risk factor, we will follow specific protocols to minimize the risk of infection to our team and other clients. We ask you to complete the following questions regarding yourself.

Name
First Last
Phone
Email
Are you currently experiencing any flu or cold symptoms?*
- Fever and/or chills: Temperature of 37.8 degrees Celsius/100 degrees Fahrenheit or higher
- Cough or barking cough (croup): Continuous, more than usual, making a whistling noise when breathing (not related to asthma, post-infectious reactive airways, COPD, or other known causes or conditions you already have)
- Shortness of breath: Out of breath, unable to breathe deeply (not related to asthma or other known causes or conditions you already have)
- Decrease or loss of taste or smell: Not related to seasonal allergies, neurological disorders, or other known causes or conditions you already have
- Muscle aches/joint pain: Unusual, long-lasting (not related to getting a COVID-19 vaccine in the last 48 hours, a sudden injury, fibromyalgia, or other known causes or conditions you already have)
- Extreme tiredness: Unusual, fatigue, lack of energy (not related to getting a COVID-19 vaccine in the last 48 hours, depression, insomnia, thyroid dysfunction, or other known causes or conditions you already have)
- None of the above
Choose any/all that are new, worsening, and not related to other known causes or conditions you already have.
Have you travelled outside of Canada in the last 14 days?
In the last 14 days, have you been in close physical contact with someone who:

Tested positive for COVID-19
Is currently sick with a new cough, fever, or difficulty breathing
Returned from outside of the country in the last 2 weeks?
Close physical contact means: • speaking with someone less than 2 metres away for over 15 minutes • being in the same room or workspace for over 15 minutes • living in the same home
Your pet’s health is our number 1 priority! Your pet cannot talk to us so, therefore we ask you to complete the following questions in regards to the health of your pet. Please pick the type of appointment that you have scheduled with us below:
Annual Wellness Exam - Dog

Annual Wellness Exam - Cat

Medical Appointment
If entering our hospital we require you to wear a mask at all times and to keep a distance of 6 feet. We have hand sanitizer available to be used frequently.
Thank you for working with us to keep everyone happy and healthy.

Pet feeling blue? Try our pet symptom checker. Pet Health Checker

COVID Intake Form

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