Pre-Visit Questionnaire

Pre-Visit Questionnaire

Fill this form out prior to your pet's appointment. It's always helpful if you can do so at least 48 hours prior to the appointment. Thanks for letting us take care of your pet!
Pet's Name *
Owner's Name *

First Name Last Name
Phone Number *
Please enter a valid phone number.
Email
example@example.com
Does your pet show any reluctance to getting in the carrier or car?

Yes No
How and where does your pet travel in car? (carrier, seatbelt, loose, etc.)
During travel to the veterinary hospital, does your pet do any of the following:

Eager & Excited Subdued Reluctant Hide Bark/Meow Pant Whine Tremble Pace Drool Vomit Urinate/Defecate Other
Does your pet prefer:
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 the carrier or 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 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
How would you describe your pet around other animals and people?
Does your pet have any sensitive areas that they do 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 trims, weight, temperature, ear exam, blood draw) If so, how did your pet react?
What are your pet's favorite treats?
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?
Should be Empty:

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