SCREENING FORM

PAW CHECK-IN

(required)

Pet Owner's Name

Date

Pet's Name

What color/model is your car?

(optional)

Does your pet have any allergies to food or medications?

Do you need us to prepare any refills in advance of the visit?

Do you need assistance helping your pet to/from the car?

Do you have any specific questions or new concerns regarding your pet or questions regarding the visit prior to arrival and check-in? If so, an assistant will call you prior to intake.

Covid-19 Screening Assessment

(required)

Do you have a cough, shortness of breath or difficulty breathing?
Do you have a fever now or have you had a fever in the past 14 days? (temp above 99.9°F)
Have you experienced recent loss of taste or smell?
Have you come in contact with any confirmed COVID-19 positive persons in the last 14 days?
Have you traveled by air in the past 14 days?

"NO" I have not experienced any of the above.

OR

"YES", I have experienced one or more of the above. Please contact us at 818-847-7299

PAW CHECK-IN

(required)

(optional)

Covid-19 Screening Assessment

Do you have a cough, shortness of breath or difficulty breathing?

Do you have a fever now or have you had a fever in the past 14 days? (temp above 99.9°F)

Have you experienced recent loss of taste or smell?

Have you come in contact with any confirmed COVID-19 positive persons in the last 14 days?

Have you traveled by air in the past 14 days?

OR

2017 SPOTLIGHT PRACTICE!

OUR ADDRESS

OPENING HOURS