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COVID-19 QUESTIONNAIRE
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Covid-19 Questionnaire
First Name
*
Last Name
*
Email Address
Date of Visit
*
Date Format: MM slash DD slash YYYY
Phone Number
*
In the past 14 days have you or anyone in your household traveled outside of Nova Scotia?
*
Yes
No
Are you or anyone in your household showing signs of illness?
*
Yes
No
Have you or any member of your household been in close contact with anyone who has had to self-quarantine?
*
Yes
No
Has your pet been in contact with anyone showing signs of illness?
*
Yes
No
Have you visited any of the exposure sites during the date and times indicted by Public Health?
*
Yes
No
Have you been in contact with anyone who has had a potential exposure?
*
Yes
No
PLEASE READ:
Thank you for filling out our questionnaire. Our goal is to do everything we can to protect our staff and visitors. We ask that you make sure a mask is available upon arrival. Please respect the guidelines for social distancing, mask use, and restrictions suggested by Public Health. If at any time you answered YES to any of the above questions reach out to the clinic at 902 576 2068 before departing to arrive at the clinic.
PLEASE CONTACT US.
Home
New Clients
New Client Registration Form
Transfer Files
About Us
Team
Services
All Services
Puppy Training Classes
Fetching Dog Grooming
Pet Health
Covid-19 Update
Pet Health Library
Pet Insurance
How-To Videos
Pet Health Checker
Pet Food Recalls
Product Recalls
News
Contact Us
COVID-19 QUESTIONNAIRE
Registered Clients
Make an Appointment
Prescription Refill and Food Order Request Form
Emergency Care
Shop Online
Payment Plans
COVID-19 Policy
