*Name

*Phone

Alternative Phone

*Pet's Name

*We have a few questions about coronavirus risk as this impacts precautions we take while handling pets.

1. Has anyone in your household had flu-like symptoms, been exposed to coronavirus, been under quarantine for coronavirus, or been diagnosed with coronavirus during the past two weeks? IF THE ANSWER TO THIS QUESTION IS YES - DO NOT CONTINUE WITH THE FORM. INSTEAD, CALL US AT (864) 972-9994 FOR ADVICE ON HOW TO PROCEED. DO NOT ARRIVE FOR YOUR APPOINTMENT WITHOUT SPEAKING TO US FIRST.

*What food does your pet eat?

*Any supplements/people food

*How has your pet been feeling since his/her last visit? (Please give details including whether he/she is better or worse or the same)

*How is your pet feeling?

*Appetite

*Drinking/urination

*Any vomiting?

*Any diarrhea?

*Any coughing, sneezing, or nasal discharge in the past two weeks? If yes, describe

Please list all the medications you are currently giving your pet and how frequently you are giving them. Please list even if you were prescribed them by us as we want to confirm your pet is still receiving them. Please note if your pet has missed any doses within the past week and when it was missed. List the times you last gave each medication. (example: Furosemide 12.5 mg 1 tab once daily, last given at 8am today, one dose missed yesterday morning)

*Is there anything else we need to know?

Please note: We will do an examination and basic testing/medications and then Dr. Jordan will give you a call to discuss the treatment plan. Once we have completed tests and treatments, we will call you and set up a pick up time. We will take payment at that point over the phone. Do you have any questions or concerns?