Pet Health Questionnaire

Client Name *

First Name

Last Name

FOR CLIENT: Have you had any COVID symptoms? A COVID diagnosis lately? Or Close contact to anyone with COVID? *

We are still able to see your pet even if you are experiencing COVID related symptoms; it just changes our protocol for treating your pet so we can better protect our staff.

Yes

No

Do you need prescriptions refilled today? *

Yes

No

Is your pet EATING & DRINKING normally? *

Yes

No

Is your pet URINATING & DEFECATING normally? *

Yes

No

Any COUGHING or SNEEZING? *

Yes

No

Any VOMITING or DIARRHEA? *

Yes

No

Any changes to your pet’s activity level? *

Yes

No

Have you noticed changes in behavior? *

Yes

No

Is your pet exhibiting any signs of pain? *

Yes

No

(CATS ONLY): Does your cat go outside?

Yes

No

(DOGS ONLY): Does your dog go to any of the following:

Dog Parks

Doggy Daycares

Boarding or Training Facilities