Pre-Visit Questionnaire
As Fear Free Certified Professionals, we want to make your pet's veterinary visit as enjoyable and as stress free as possible. As such, it is important for us to understand what your pet might find upsetting. This information will help us to adjust our care to better serve and comfort your pet. Please answer the following questions to the best of your ability so we can take into consideration both your and your pet's preferences.
Client Name
Dr.
Mr.
Mrs.
Ms.
Prefix
First Name
Last Name
Pet's Name
Does your pet show any reluctance getting into the carrier or the 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 (click all that apply):
Eager & Excited
Reluctant
Hide
Drool
Vomit
Urine/BM
Subdued
Bark/Meow
Whine
Pant
Tremble
Pace
Does your pet prefer:
Female Veterinary Professional
Male Veterinary Professional
It does not matter
Check any situations below that your pet has shown avoidance or dislike of in the past. You can add additional comments at the end.
Getting in the carrier or car
Entering the veterinary hospital
Other pets and/or people passing by while in reception/check-in
Having direct eye contact with the technician and/or veterinarian
Waiting with other people and animals in the waiting area
Getting on the scale for a weight
Hearing the doorbell, overhead intercom or phones ringing
Going into the exam room
Being put up on the table for examination
Being approached by the veterinary staff
Loud voices during examination
Having a rectal temperature taken
Being taken out of the exam room for procedures
Sounds coming from the back areas of the practice
The use of instruments such as the stethoscope or otoscope (to look in the ears)
How would you describe your pet around other animals and people?
Does your pet have any sensitive areas that (s)he does not like to have touched by you or others?
Are there any procedures your pet has not liked having performed at the veterinary hospital in the past or that seemed difficult for you or the staff to do? (nail trim, temperature, weight, ear exam, blood draw, etc.) If so, how did your pet react?
What are your pet's favorite treats (please bring some to your next visit at our hospital):
Does your pet like to play with toys? If so, what kinds?
Has your pet ever been prescribed any supplements or medications to help with a visit to the veterinary hospital? If so, what was it and what sort of results did you experience?
Is there anything else you would like us to know?
Submit
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