Pre-Visit Questionnaire

Vanguard Veterinary Hospital

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Fear Free Pre-Visit Questionnaire

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

* Indicates required field

Client's Name *

First

Last

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Pets Name *

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 Reluctant Hide Drool Vomit Urine/BM Subdued Bark/Meow Whine Pant Tremble Pace

Check any situation listed below that your pet has shown avoidance or dislike of in the past. *

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 a 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

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? *

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? *

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? *

Does your pet like to play with toys? If so what kinds? *

What are your pet's favorite treats? (Please bring some to your next visit to our hospital): *

Anything else you would like us to know? *

Submit

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OFFICE HOURS
Monday 8:00 am to 5:00 pm
Tuesday 8:00 am to 5:00 pm
Wednesday 8:00 am to 5:00 pm
Thursday 8:00 am to 5:00 pm
Friday 8:00 am to 5:00 pm
Saturday Closed
Sunday Closed

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VANGUARD VETERINARY HOSPITAL
1995 Juniper Lake Rd.
West End, NC 27376
Phone (910) 420-2902
Fax (910) 420-2847

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​Fear Free Pre-Visit Questionnaire​

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Fear Free Pre-Visit Questionnaire