Fear Free Pre-Visit Questionnaire

Date*

Pet Name*

As Fear Free Certified Professionals we want to make your pet's veterinary experience as enjoyable and 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.

Does your pet show any reluctance to getting in the carrier or car?*

Yes

No

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

Subdued

Reluctant

Bark/Meow

Hide

Whine

Drool

Pant

Vomit

Tremble

Urine/BM

Pace

Other

Does your pet prefer*

Female veterinary professional

Male veterinary professional

It doesn't matter

Other

Check any situations listed below that your pet has shown avoidance or dislike of in the past. you can add additional comments in the next section.*

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 room

Being approached by veterinary staff

Getting on the scale for weight

Hearing the doorbell, overhead intercome or phones ringing

Sounds coming from the back areas of the practice

Going into their 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 a stethoscope or otoscope (to look in the 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 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 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? (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?*