Greenbrier Veterinary Clinic

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IN PERSON VISIT

Owners Name: *

Pets Name: *

Appointment Date: *

YYYY

Primary reason for your pets visit today (If limping, please notate which leg. If a lump or wound has been noticed, please describe the location): *

How long has your pet been experiencing this problem?

Please describe the symptoms you are noticing:

Has your pet been eating, drinking, urinating, and having bowel movements normally? If no, please describe. *

Has your pet had any coughing, sneezing, vomiting or diarrhea? If yes, please describe. *

What type of pet food and/or treats, and what amount are you currently feeding?

Is your pet on any medications or supplements currently? If yes, please describe. *

Do you need any medication or food refills today? *

YES

Does your pet need any Heartworm or Flea and Tick preventatives today? *

Yes

Required

Any other information or concerns we should know about today's visit?

Have you had any of the following symptoms in the past 48 hours: *

Fever or chills, shortness of breath, fatigue, muscle or body aches, headache, new loss of taste or smell, congestion or runny nose and/or vomiting?

None of the above

Are you isolating or quarantining because you tested positive for COVID-19 or are worried that you may be sick with COVID-19? *

Yes

Are you fully vaccinated OR have you recovered from a documented COVID-19 infection in the last 3 months? To be considered fully vaccinated, you must be >2 weeks following receipt of the second dose in a 2-dose series or >2 weeks following receipt of one dose of a single-dose vaccine. (You may decline to answer this question if you are not comfortable answering) *

Yes

Decline answering

Have you been in close physical contact in the last 14 days with anyone who is known to have laboratory-confirmed COVID-19. Or anyone who has any symptoms consistent with COVID-19? *

Yes

Are you currently waiting on the results of a COVID-19 test? *

Yes

Have you traveled in the past 10 days? Travel is defined as any trip that is overnight AND on public transportation (plane, train, bus, Uber, Lyft, cab, etc.) OR any trip that is overnight And with people who are not in your household. *

Yes

I certify that my responses are true and correct *

Yes

Required

Current Covid-19 In Person Protocol

Thank you for scheduling your pet’s appointment with Greenbrier Veterinary Clinic. We look
forward to seeing you and your furry family member on your upcoming visit. Please see the below instructions for what to expect at your pet’s appointment:

 If anyone has had contact with a person with COVID-19, is under quarantine, or is experiencing flu
like symptoms, please call the office prior to coming in or find another individual to bring the patient.
 Upon arrival, please pull into one of the numbered parking spots outside of the office.
 Please remain inside your vehicle and TEXT the office at 410.838.2255 to let us know you have arrived
and which numbered parking spot you are in.
 All dogs must be on a leash or inside a carrier (if small). All cats should be secure in a closed carrier.
 One of our team members will come out to your vehicle to get you and your pet. Team members will not enter your car to
retrieve or return pets! Please wear a face mask when you are in close proximity with one of our team members and at all times inside of the clinic.
 Upon entering our clinic, we will check your temperature and ask you to sanitize your hands. You and your pet will be brought in to one of our exam rooms and the Doctor will perform your pet's exam. Due to the amount of in person visits we will be accommodating, all visits will be limited to 15 minute appointment times inside the clinic. If further discussion with the doctor is needed, we will ask that you return to your vehicle and the doctor will speak with you over the phone. If your pet requires any treatments, we will ask you to wait in your car and when all agreed upon services are completed, your pet will be returned to you with any medications and discharge instructions. If your pet requires a more in-depth workup, we may ask to keep your pet to complete our evaluation.
 If you have a temperature exceeding 100 degrees, we will request that you remain in your car and we will continue with a curbside appointment.
 For check out and payment, our Client Service Representative will call you once all charges are together to collect payment over the phone.

We are grateful that we are able to continue to care for your pet(s) during this difficult time. Please know that we will care
for your pet with the same compassion and gentle care as if you were in the exam room with us! If you
have any concerns or questions about this new process, we are happy to discuss it further to give you peace
of mind! We look forward to seeing you at the office and hope that everyone stays healthy and safe!

Best Regards,
The Doctors & Team Members of Greenbrier Veterinary Clinic

Please check the box that you have read and understand our protocol.

Yes

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