COVID-19 Declaration Form

The information you provide is important in minimizing the risk of COVID-19 transmission.


Client Details

DECLARATION

Have you travelled interstate or outside Australia in the past 14 days?







Do you have flu-like symptoms e.g. fever, cough etc?



Have you come in close contact with someone who has travelled interstate or internationally in the past 14 days?



Have you come in close contact with someone who is a confirmed COVID-19 case in the last 14 days?



Has the pet come in close contact with someone who is a confirmed COVID-19 case in the last 14 days?



I acknowledge that the information here is true and correct. I agree to notify the veterinary practice of any change in status, including diagnosis with COVID-19 and/or quarantine, within 14 days.

Signature


Clear