COVID-19 Screening Questionnaire Please complete this Visitor Screening Form just prior to entering Wilmot Veterinary Clinic Please enable JavaScript in your browser to complete this form.Visitor Name: *Visitor Contact Number: *1. Are you exhibiting any of the following symptoms? (please check all that apply) *Fever or chillsDifficulty breathing or shortness of breathCoughSore throat, trouble swallowingRunny nose/stuffy nose or nasal congestionDecrease or loss of smell or tasteNausea, vomiting, diarrhea, abdominal painNot feeling well, extreme tiredness, sore musclesNone of the above2. Have you travelled outside of Canada in the past 14 days? *YesNo3. Have you had close contact with a confirmed or probable case of COVID-19? *YesNoSignature *Clear SignatureDate *NameSUBMIT
