204 Elm St
Milford, NH, 03055
603-673-6101
info@milfordveterinaryhospital.com
Pre-Visit Questionnaire Form
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’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 you and your pet’s preferences.
Your Name
First Name
Last Name
Email
example@example.com
Phone Number
-
Area Code
Phone Number
Pets Name
Pets Species
Pets Breed
PLEASE BE AWARE THAT THIS FORM DOES NOT SCHEDULE AN APPOINMENT
Please call the hospital to schedule, 603-673-6101
How would you describe your pet’s reaction to going to the veterinary hospital?
*
Eager and Excited
Subdued
Reluctant
Somewhere in between
Other
Are there things you or your pet did not like during past veterinary visits?
*
Being Weighed
Getting on the exam table
Having a procedure done
Being handled by veterinary staff
Walking through clinic
Entering Clinic
Other
How would you describe your pet around other animals and people, such as in the lobby are of the hospital?
*
Does your pet prefer
*
Female Veterinary Professionals
Male Veterinary Professionals
It doesn't matter/Unsure
What are your pets favorite treats?
*
Does your pet like to play with toys? if so, what kind?
Has your pet ever been prescribed any medications to help with a visit to the veterinary hospital? If so, what medications were they and what sort of results did you experience?
How and where does your pet travel in the car?
Carrier/Crate
Seatbelt
Loose
Other
Does your pet show any reluctance to getting in the carrier or car?
Yes
No
Other
How does your pet behave in the car? How does your pet behave in the car?
*
Vocal
Barking
Whining
Restless
Pacing
Drooling
Trembling
Hiding
Other
Any nausea, drooling or vomiting with car travel?
Yes
No
Other
Please verify that you are human
*
Submit
Should be Empty: