Fear Free Pre-Visit Client Questionnaire Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pet’s before your visit.

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Fear Free Pre-Visit Client Questionnaire Form

As a Fear Free Certified Professional team, we want your pet’s veterinary experience to be 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.

Your Name *

First

Last

Pet Name *

How would you describe your pet's reaction to going to the veterinary hospital?

Eager and Excited
Subdued
Reluctant
Somewhere in between

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
Going into the exam room
Entering the veterinary hospital
Being put up on the table for examination
Other pets and/or people passing by while in reception / check-in
Having direct eye contact with the technician and/or veterinarian
Waiting with other people and animals in the waiting area
Loud voices during examination
Being approached by veterinary staff
Having a rectal temperature taken
Getting on the scale for a weight
The use of instruments such as stethoscope or otoscope
Being taken out of the exam room for procedures
Hearing the doorbell, overhead intercom, or phones ringing
Sounds coming from the back areas of the practice

Does your pet exhibit signs of fear, anxiety, or stress in the car? Does your pet have difficulty getting into its carrier?

Does your pet show signs of nausea with car travel, such as drooling or vomiting?

How would you describe your pet around other animals and people?

Does your pet have any sensitive areas that he does not like to have touched or examined?

Are there any procedures your pet has not liked 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 or flavor of treats?

Has your pet ever been prescribed any medications to help with a visit to the veterinary hospital? If so, please list below:

Anything else you would like us to know?