Annual Exam: Pre-Visit Questionnaire
We look forward to seeing you and your pet at your upcoming Annual Exam! Once a year, we ask that you complete this Pre-Visit Questionnaire so that our team can review your pet's history, nutrition, and emotional medical record prior to your visit. Please take a moment to answer the following questions before your appointment.
Date Picker Icon
Primary Client Name
Primary Phone Number
Street Address Line 2
State / Province
Postal / Zip Code
Antigua and Barbuda
Bosnia and Herzegovina
Central African Republic
Cocos (Keeling) Islands
Democratic Republic of the Congo
Turkish Republic of Northern Cyprus
Papua New Guinea
Republic of the Congo
Saint Kitts and Nevis
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Sao Tome and Principe
Trinidad and Tobago
Tristan da Cunha
Turks and Caicos Islands
United Arab Emirates
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Secondary Phone Number
Reason for Visit
How did you hear about Animalia?
Do you have pet insurance? If so, what company?
Upload a photo of your pet!
Nutrition & Medical History Assessment:
We believe that nutrition is the foundation of good health for our pets. Complete and balanced nutrition can be found in a variety of diets, including over the counter, prescription, and homemade diets designed by veterinary nutritionists.
What is your pet's current diet? How much do you feed and what measuring device do you use? (ex: 1/2 cup, twice daily, standard measuring cup)
Do you free feed your pet or are they given scheduled meals?
Do you feed any other type of food? (ex: fruits, veggies, scrambled eggs, boiled chicken, etc.)
Does your pet or anyone in your household have a food allergy?
Does your pet have any previously diagnosed medical conditions?
Is your pet currently taking any medications or preventative medications (flea, tick and heartworm preventatives)? What dosage?
Has your pet had any surgeries other than his/her spay or neuter?
Are you interested in integrative therapies for your pet such as acupuncture, herbal medications, or physical rehabilitation?
Has your pet ever had a reaction to a vaccine or medication?
Are you interested in knowing more about titers vs. vaccinations?
Please provide the name and phone number of previous clinics where we can obtain medical records. This information can also be emailed directly to us at email@example.com
Creating A Fear Free Visit:
As a Fear Free Certified team, we want to make your pet's veterinary experience as enjoyable and stress free as possible. 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 you and your pet's preferences.
Does your pet show any reluctance to getting in the carrier or car? How and where does your pet travel in the car? (carrier, seatbelt, loose, etc.):
During travel to the veterinary hospital, does your pet do any of the following:
Eager & excited
Does your pet prefer:
Female veterinary professional
Male veterinary professional
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 their carrier or the 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 phones ringing
Sounds coming from the back areas of the practice
Going into the exam room
Being put up on the table for examination
Having direct eye contact with the technicians and/or veterinarian
Loud voices during examination
Having a rectal temperature taken
The use of instruments such as the stethoscope or otoscope (checking 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 he/she 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? (nail trims, weight, temperature, ear exam, blood draw). If so, how did your pet react?
What are your pet's favorite treats and how often do you give them? Do you give your pet any chews or dental treats? We offer treats during every exam, but bringing some of their favorite treats from home is also helpful!
Does your pet like to play with toys? If so, what type of toys does he/she enjoy?
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? If possible, take a photo of the bottle label with your mobile phone and bring to exam. Knowing the name, strength, and frequency of dosing is very important.
Anything else you would like us to know?
Should be Empty: