TotalBond Bethel - Pre-Visit Client Questionnaire

1
As a Fear Free Certified Professional team, we want to make your pet’s veterinary experience as enjoyable and as stress free as possible. As such, it’s important for us to understand what your pet might find upsetting. The 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 & your pet’s preferences.
2
First Name
Last Name
Phone
Email
3
How would you describe your pet’s reaction to going to the veterinary hospital?
Eager and Excited
Subdued
Reluctant
Somewhere in between
4
Check any situations listed below that your pet has shown avoidance or dislike of in the past. You can add additional comments at the end.
Getting in their carrier or the car
Entering the veterinary hospital
Other pets and/or people passing by while in reception/check-in
Waiting with other people and animals in the waiting area
Being approached by veterinary staff
Getting on the scale for a weight
Hearing the doorbell, overhead intercom, or phones ringing
Sounds coming from the back areas of the practice
Going into the exam room
Being put up on the table for examination
Having direct eye contact with the technician and/or veterinarian
Loud voices during examination
Having a rectal temperature taken
The use of instruments such as the stethoscope or otoscope (to look in the ears)
Being taken out of the exam room for procedures
5
How and where does your pet travel in the car? (carrier, seatbelt, loose, etc.)
6
How does your pet behave in the car?
7
Does your pet show any signs of nausea with car travel, such as drooling or vomiting?
8
How would you describe your pet around other animals and people?
9
Does your pet have any sensitive areas that he does not like to have touched or examined by you or others?
10
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 trims, weight, temperature, ear exam, blood draw) If so, how did your pet react?
11
What are your pet’s favorite treats? (Please bring some to your next visit to our hospital)
12
Does your pet like to play with toys? If so what kinds?
13
Has your pet ever been prescribed any medications to help with a visit to the veterinary hospital? If so, please list below:
14
Anything else you would like us to know?
Should be Empty: