Pre-Visit Questionnaire | Carlsbad, CA | Companion Animal Wellness Center

As Fear Free Certified Professionals, 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 you and your pet's preferences. You can reach us at 760-444-0342. Thank you

Owner First Name:

Owner Last Name:

Email:

Phone number where you can be reached:

Pets Name:

Type of Pet (dog/cat/bird/reptile etc):

Pet Insurance(if Applicable):

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

How and where does your pet travel in the car? (carrier, seatbelt, loose etc.)

Type of Pet (dog/cat/bird/reptile etc):

During travel to the veterinary hospital, does your pet do any of the following? If you have a BIRD, skip and see below.

Eager & Excited

Subdued

Reluctant

Bark/Meow

Hide

Whine

Drool

Pant

Vomit

Tremble

Urine/BM

Pace

Other (explain below)

If your pet is a BIRD, during travel to the veterinary hospital, does your bird do any of the following?

Eyes wide open

Feathers slicked tight

Freezing in place

Darting looks

Increased Respiration

Vocalizing

Chewing Toes

Eyes pinning

Defecating

Crouching/Quivering wings

Trying to fly away/escape

Feather loss

Other (explain below)

Female veterinary professional

Male veterinary professional

It doesn't matter

Getting in their carrier or the car

Entering the veterinary hospital

Other pets and/or people passing by while in reception/check-in

Being approached by veterinary staff

Getting on the scale for a weight

Hearing the doorbell, overheard intercom, or phone 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 ear)

Being taken out of the exam room for procedures

Does your pet have any sensitive areas that they do 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 trim, weight, temperature, ear exam, blood draw etc.) If so, how did your pet react?

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

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?