Pre-Visit Questionnaire
Thank you for taking a few minutes to help us taking the best care of your pet!
Pet Owner Name:
First Name
Last Name
Pet's Name:
Pet name
Does you pet show any reluctance getting into the carrier or the car?
Yes
No
How and where does your pet ride in the car? (seatbelt, loose, etc):
During travel to the veterinary hospital, does your pet exhibit any of the following behaviors?
Eager/Excited
Reluctance
Barking/Meowing
Drooling
Hiding
Subdued
Panting
Whining
Vomiting
Trembling/Shaking
Urine/BM
Pacing
Does your pet have a gender preference for provider?
Male practitioner
Female practitioner
Other
Check any situations that your pet has shown avoidance or dislike of in the past.
Getting into the carrier/car
Getting on the scale
Sounds coming from the rest of the hospital
Entering the vet hospital
Going into the exam room
Being put on the table for an exam
Direct eye contact with tech or doctor
Instruments such as a stethoscope
How would you describe your pet around other animals?
How would you describe your pet around new people?
Does your pet have any areas they do not like having touched?
Are there any procedures your pet did not like having performed? If so, what was their reaction? (ex: nail trims, blood draw, etc)
Does your pet have any food sensitivities? (We like to feed treats, but don't want to make your pet ill!)
Has your pet ever been prescribed any supplements or medications to help with a visit to the veterinary hospital? If so, what medication and how did they react?
Is there anything else you'd like us to know?
Submit
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