Fear Free Form
As a Fear Free Certified Professional team, we want to make you pet's veterinary experience as enjoyable and stress free as possible. As such, it's 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 & your pet's preferences.
Client Information
Client Name
*
First Name
Last Name
Pet Name:
*
Does your pet show any reluctance to get in the carrier or car?
*
Please Select
Yes
No
How and where does your pet travel in the car? (carrier, seatbelt, loose, etc.):
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During travel to the veterinary hospital, does your pet do any of the following:
Eager & excited
Reluctant
Hide
Drool
Vomit
Urine/BM
Subdued
Bark/Meow
Whine
Pant
Tremble
Pace
Other
Does your pet prefer:
*
Female Veterinary Professional
Male Veterinary Professional
It Doesn't Matter
Check any situations listed below that your pet has shown avoidance or dislike of in the past:
Getting in their carrier or car
Entering the veterinary hospital
Other pets and/or people passing by while in the reception area
Waiting with other people and/or 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 area of the hospital
Going into the exam room
Being put on the table for examination
Having direct eye contact with the technician or doctor
Loud voices during examination
Having a rectal temperature taken
The use of instruments such as a stethoscope or otoscope (to look in the ears)
Being taken out of the exam room for procedures
How would you describe your pet around other animals and people?
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Does your pet have any sensitive areas that s/he does not like to have touched by you or others?
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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?
*
What are your pet’s favorite treats? (Please bring some to your next visit to our hospital):
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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?
*
Anything else you would like us to know?
Date
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Month
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Day
Year
Date
Submit
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