Fear Free Visit Form Please answer the questions below so that we can help you and your pet have a comfortable and fear free visit. Step 1 of 2 50% Client InformationOwner's Information* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Primary Contact Number*Email* Pet InformationName*How would you describe your pet's reaction to going to the vet?* Eager & Excited Subdued Reluctant Somewhere inbetween Please check any situations listed below that your pet has shown avoidance or dislike of in the past.*You may add additional comments at the end. 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 room for procedures Additional comments:*How and where does your pet travel in the car? (carrier, seatbelt, loose, etc.)*How does your pet behave in the car?*Does your pet show any signs of nausea with car travel such as drooling or vomiting?* Drooling Vomiting Drooling & Vomiting No signs How would you describe your pet's behavior around other animals and people?*Does your pet have any sensitive areas that he/she does not like to have touched or examined by you or others?*Are there any proceedures your pet has not liked having performed at the vet 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 visit!)*Does your pet like to play with toys? If so, what kinds?*Has your pet ever been prescribed medications to help with a visit to the vet? If so, please list below*Is there anything else you would like us to know to help make your pet as comfortable as possible?*Do you have another pet you'd like to tell us about?* Yes No Name*Species*How would you describe your pet's reaction to going to the vet?* Eager & Excited Subdued Reluctant Somewhere inbetween Please check any situations listed below that your pet has show 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 room for proceduresHow and where does your pet travel in the car? (carrier, seatbelt, loose, etc.)*How does your pet behave in the car?*Does your pet show any signs of nausea with car travel such as drooling or vomiting?* Drooling Vomiting Drooling & Vomiting No signs How would you describe your pet's behavior around other animals and people?Does your pet have any sensitive areas that he/she does not like to have touched or examined by your or others?*Do you have another pet you'd like to tell us about?* Yes No Name*Species*How would you describe your pet's reaction to going to the vet?* Eager & Excited Subdued Reluctant Somewhere inbetween Please 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 room for proceduresHow and where does your pet travel in the car? (carrier, seatbelt, loose. etc.)*How does your pet behave in the car?*Untitled* Drooling Vomiting Drooling & Vomiting No signs How would you describe your pet's behavior around other animals and people?*Does your pet have any sensitive areas that he/she does not like to have touched or examined by your or others?*Are there any proceedures you pet has not liked having performed at the vet 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 them with you to your visit!)*Does your pet like to play with toys? If so, what kinds?*Has your pet ever been prescribed medications to help with a visit to the vet? If so, please list below.*Anything else you'd like us to know?*THANK YOU!PhoneThis field is for validation purposes and should be left unchanged.
