Required Pre-appointment COVID-19 Screening:

As you may know, pets can become infected with coronavirus. For more information about your upcoming appointment and/or pets and COVID-19, go to Paoli Vetcare—Latest on COVID/Coronavirus & Pets.

Please answer the following questions the best of your ability. This information is confidential. We will see your pet even if you answer YES to any of the questions. We use your answers to determine the appropriate level of PPE for our doctors and staff:

COVID-19 Screening Form

Have you, any household member, or a pet been in close proximity to someone quarantined, tested, presumed positive, or diagnosed with COVID-19 in the past 3 weeks? (required):
YesNo
Do you have any reason to believe you or anyone in your household has been exposed to or acquired COVID-19? (required):
YesNo
Have you or anyone in your household visited or received treatment in a hospital, nursing home, long-term care, or other health care facility in the past 30 days? (required):
YesNo
Have you or anyone in your household traveled in the US, internationally or on a cruise ship in the last 21 days? (required):
YesNo
Do you, any household member, or a pet have any of the following symptoms? (required):

  • cough
  • shortness of breath/difficulty breathing
  • fever (people: ≥100 Degrees F)
  • chills or shaking
  • muscle pain
  • headache
  • sore throat
  • new loss of taste or smell
  • vomiting
  • diarrhea
  • lethargy
  • sneezing
  • nasal discharge
  • ocular discharge

YesNo

Do you have any additional comments?