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Pre-Visit Questionnaire ( form 3 of 3)
Please complete this Pre-Visit Questionnaire as part of our New Client Information forms.
Client Information
Date
Date Format: MM slash DD slash YYYY
Name
First
Last
Pet's Name:
Does your pet show any reluctance to getting in the carrier or car?
Yes
No
How and where does your pet travel in the car? ( carrier, seatbelt, loose, etc.)
During travel to the veterinary hospital, does your pet do any of the following:
Eager & excited
Subdude
Reluctant
Bark/ Meow
Hide
Whine
Drool
Pant
Vomit
Tremble
Urine/ BM
Pace
Other
If other:
Does your pet prefer:
Female veterinary professional
Male veterinary professional
It doesn't matter
Check any situations below that your pet has shown avoidance or dislike of in the past.
Getting out of the carrier or car
Entering the veterinary hospital
Other pets/ or people passing while in reception/ check-in
Being approached by veterinary staff
Getting on the scale for a weight
Hearing the doorbell, overhead intercom or phone ringing
Sounds coming from the back of the practice
Going to the exam room
Being put on the examination table
Having direct eye contact with the technician/ or vet
Loud voices during examination
Having a rectal temperature taken
The use of instruments such as the stethoscope or otoscope ( for ears)
Being taken out of the exam room for procedures
How would you describe your pet around other people?
Are there any procedures your pet has not liked having performed at the veterinary hospital in the past that seemed difficult for you or the staff to do? If so, how did your pet react?
( nail trims, weight, temperature checks, ear exam, blood draw)
What are your pet's favorite treats? ( please bring some to your next visit)
Does your pet like to play with toys? If so, what kinds?
Has your pet ever been prescribed any supplements or medication to help with a visit to the veterinary hospital? If so, what was it and what sort of results did you experience?
Anything else you would like us to know about your pet?
Home
About Us
Our Team
About Fear Free
Take A Tour
Client Center
New Client Application Form
New Client Information Forms
Request an Appointment
Pet Portal
Services
Wellness & Vaccines
Dentistry
Surgical Services
Alternative & Integrative Therapy
Hospice & Palliative Care
Premium Dog Grooming
More Services
Pet Health
Pet Health Checker
Pet Health Library
How-To Videos
Pet Food Recalls
Product Recalls
News
Contact Us
