Fear Free Questionnaire
Email address *
Client first and last name
Your answer
Pet's name
Your answer
How would you describe your pet's reaction to coming to the vet?
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
If your pet is a dog, are they on any heartworm prevention? If so what kind and are they on it year-round or seasonally?
Your answer
What kind of food does your critter eat?
Your answer
Is your pet due for any vaccinations?
Your answer
Does your pet have any food allergies? If so please list them below:
Your answer
Do you or your family members have any food allergies we should know about? We routinely use peanut butter, cheeses and other allergens in our hospital.
Your answer
Do you have any current concerns about your pet's health?
Your answer
How and where does your pet travel in the car? (carrier, seat belt, loose, ect)
Your answer
How does your pet behave in the car?
Your answer
Does your pet show any signs of nausea with car travel, such a drooling or vomiting?
Your answer
How would you describe your pet around other animals and people?
Your answer
Does your pet have any sensitive areas that he doesn't like to have touched or examined by you or others?
Your answer
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?
Your answer
What are your pets favorite treats? ( please bring some to your next visit to our hospital, and please bring your pet hungry)
Your answer
Does your pet like to play with toys? If so what kinds?
Your answer
Has your pet ever been prescribed and medications to help with a visit to the veterinary hospital? if so, please list below
Your answer
Anything else you would like us to know?
Your answer
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of Critter Care Animal Hospital. Report Abuse