Russell Vale Animal Clinic

17 Bellambi Lane
Bellambi, NS 2518

(024)284-5988

www.animalclinic.com.au

Welcome - Thank you for choosing Russell Vale Animal Clinic for your pet's visit.  You care about the health and wellbeing of your pet, and we will endeavour to fulfill your needs.

Due to COVID-19, we are introducing strict new protocols to ensure your safety and ours.  Fortunately, our pets cannot get COVID 19 but we can get it from you, or you from us. 

COVID 19 FECAVA

Owners Declaration:  Submitting the form means that you agree to the declaration below.

1. I am the owner/guardian of this pet and I agree to pay all fees and charges at the time of consultation or on discharge from hospital. 

I am aware that accounts are not given by Russell Vale Animal Clinic.

I declare that at the time of the consultation, I do not have a sore throat, fever, cough or shortness of breath.

I have not been overseas or interstate in the past fourteen days. 

I have not been in contact with a COVID 19 positive person, nor know of someone with COVID 19. 

The pet does not reside or has resided with someone in the past 5 days with someone in self isolation, tested for COVID-19(whether positive or negative), or has any possible interaction with someone with any signs even remotely flu or cold like. 

I have not been told to be in self isolation or self quarantine by the Department of Health. 

I accept all directions of the staff of Russell Vale Animal Clinic. 

In clicking "submit form"  I am accepting these terms.

If you are in isolation/self quarantine or been in contact with a COVID 19 person, please contact us directly via email.  We have limited advanced PPE equipment, and we want to ensure that you and your pet i is kept safe at all times. 



Owner Details
First name
Surname
Partners name (if relevant)
Address
Home phone number
Mobile Number (primary)
Alternative mobile (secondary)
Email (essential)

Pet Details
Name
Breed
Date of Birth
Colour
Sex (male/male desexed/Female/Female desexed
Microchip Number
Pet insurance company
Submitting the form means that you agree to the declaration listed above.
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