Fear Free Pre-Visit Client Questionnaire

    Please enter Your Name:
    Pet’s Name:
    Your Email:

    Does your pet show any reluctance to getting in the carrier or car? YesNo
    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 and ExcitedReluctantHideDroolVomitUrine/BMSubduedBark/MeowWhinePantTremblePaceOther

    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 carEntering the veterinary hospitalOther pets and/or people passing by while in reception/check-inWaiting with other people and animals in the waiting areaBeing approached by veterinary staffGetting on the scale for a weightHearing the doorbell, overhead intercom, or phones ringingSounds coming from the back areas of the practiceGoing into the exam roomBeing put up on the table for examinationHaving direct eye contact with the technician and/or veterinarianLoud voices during examinationHaving a rectal temperature takenThe use of instruments such as the stethoscope or otoscope (to look in the ears)Being taken out of the exam room for procedures

    Comments:

    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? (nail trims, weight, temperature, ear exam, blood draw) If so, how did you 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?