Fear Free Pre-Visit Questionnaire

Fear Free Pre-Visit Questionnaire
As Fear Free Certified Professionals, 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 and your pet’s preferences.
Date

MonthDayYear
Date
Client’s Name
Pet’s Name
Does your pet show any reluctance to getting in the carrier?

YesNo
Does your pet prefer:

Female veterinary professionalMale veterinary professionalIt doesn't matter
Check any situations listed below that your pet has show avoidance of dislike of in the past. You can add additional comments at the end.

Going into the exam roomBeing put up on the table for examinationCheck any situations listed below that your pet has shown avoidance or dislike of in the past. You can add additional comments at the end.Other pets and/or people passing by while in reception/check-inHaving direct eye contact with the technician and/or veterinarianWaiting with other people and animals in the waiting areaLoud voices during examinationHaving a rectal temperature takenMale veterinary professionalThe use of instruments such as the stethoscope or otoscope toGetting on the scale for a weightLook in the earsUnfamiliar sounds associated with a hospital settingBeing separated from you for proceduresGetting in their carrier or the carEntering the veterinary hospitalBeing approached by veterinary staffHearing the doorbell, overhead intercom, or phones ringing
How would you describe your pet around other animals and people?
Does your pet have any sensitive areas that s/he does 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 (e.g., 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
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 your experience?
Anything else you would like us to know?
VETERINARY HEALTHCARE TEAM: Transfer all application information from questionnaire to the patient’s Fear Free Emotional Medical Record.
Should be Empty: