St. Francis Veterinary Housecall Services

4591 Van Atta Rd
Okemos, MI 48864

(517)775-1858

www.stfrancisvetmed.com

Covid 19 Precautionary Questions Form

Are you on a quarantine due to possible COVID-19 exposure?

Yes
No


Do you have a fever, shortness of breath, or cough?

Yes
No


Do you agree to wear a mask at all times you interact with us and do you agree to follow our COVID regulations and rules?

Yes
No



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