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(603) 447-3449
| Monday - Friday: 8AM - 5PM | Saturday, Sunday: Closed
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Fear Free Pre-visit Questionnaire
Client Name
(Required)
First
Last
Pet Name
(Required)
Does your pet show any reluctance to getting in the carrier or car?
(Required)
Yes
No
How and where does your pet travel in the car? (carrier, seatbelt, loose, etc.)
(Required)
During travel to the veterinary hospital, does your pet do any of the following:
Eager/excited
Reluctant
Hide
Drool
Vomit
Urine / BM
Subdued
Bark/Meow
Whine
Pant
Tremble
Pace
Other
What other behaviors does your pet exhibit?
(Required)
Does your pet prefer:
(Required)
Female veterinary professional
Male veterinary professional
It doesn't matter
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 weight
Hearing the doorbell, overhead intercom, or 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 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
Additional comments (not required)
How would you describe your pet around other animals and people?
Does your pet have any sensitive areas that she/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 your 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? (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 you experience?
Anything else you would like us to know?
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