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COVID-19 Appointment Procedures
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Pre-Visit Questionnaire (PVQ)
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Resources
Blog Center
A 10-year reflection
Acupuncture & TCVM A Natural Approach to Pain Relief? Pain
Rosie's Story
Ear cleaning with Dr. Couch
Separation Anxiety in Dogs
COVID-19 and the Effects on East-West Animal Hospital and the Veterinary Community
Healthy Mouth, Healthy Pet
Grain-free diets and your dog
Vaccines and your pet
Puppy Strangles
Pruritis: Itching and scratching in dogs
Fear Free Fun Visits!
Pet Insurance
Hills recalling can dog food
Cat Friendly Festivities
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.
*
Indicates required field
Name
*
First
Last
Pet's name
*
Does your pet show any reluctance to getting in the carrier or car?
*
Choose one
Yes
No
Does your pet prefer?
*
Choose one
Women
Men
Doesn't matter
How and where does your pet travel in the car? (carrier, seatbelt, loose, etc.)
*
How would your describe your pet around other animals/people?
*
During travel to the veterinary hospital, does your pet do any of the following:
Eager & excited
*
Yes
No
Barks / Meows
*
Yes
No
Pant
*
Yes
No
Reluctant
*
Yes
No
Subdued
*
Yes
No
Tremble
*
Yes
No
Hides
*
Yes
No
Whines
*
Yes
No
Pace
*
Yes
No
Drools
*
Yes
No
Vomits (car sick)
*
Yes
No
Urine/bowel movements
*
Yes
No
Other
*
Check any situation listed below that your pet has shown avoidance or dislike in the past.
Getting in their carrier or car
*
Avoidance
Dislike
N/A
Waiting with other people/pets in reception area
*
Avoidance
Dislike
N/A
Being approached by veterinary staff
*
Avoidance
Dislike
N/A
Entering the Veterinary Hospital
*
Avoidance
Dislike
N/A
Being placed on the table for examination
*
Avoidance
Dislike
N/A
Getting on the scale for weight
*
Avoidance
Dislike
N/A
Going into exam room
*
Avoidance
Dislike
N/A
Having direct eye contact with technician or veterinarian
*
Avoidance
Dislike
N/A
Having a rectal temperature taken
*
Avoidance
Dislike
N/A
Passing other pets or people in reception area
*
Avoidance
Dislike
N/A
Loud voices or noises
*
Avoidance
Dislike
N/A
Hearing a doorbell or phone ring
*
Avoidance
Dislike
N/A
Leaving exam room for a procedure (example X-rays)
*
Avoidance
Dislike
N/A
Use of instruments like stethoscope or otoscope (to examine ears)
*
Avoidance
Dislike
N/A
Are there any sensitive areas that they do not like touched?
*
Please check the procedures your pet has had performed at the veterinary hospital in the past and their reaction to the procedure.
Nail trim
*
No objection
Objected
Ear exam
*
No objection
Objected
Rectal temperature
*
No objection
Objected
X-ray or Ultrasound
*
No objection
Objected
Blood draw
*
No objection
Objected
Other procedures
*
What are YOUR pet's favorite treats?
*
Does your pet 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?
*
Additional information
*
THANK YOU for completing the questionnaire!
Your responses will be entered into your pet's Emotional Medical Record.
Submit
Home
COVID-19 Appointment Procedures
About
Veterinarians
Team - Techs & Assistants
Team - CSRs
Join our Team!
Services
Services
Acupuncture & TCVM
>
What to expect with TCVM
Types of Acupuncture Techniques
Behavior
Dental Care
>
What's a Dental Grade?
Products to Help Prevent Dental Disease
Other Dental Conditions
Laboratory & Diagnostics
>
Laboratory
X-ray / Radiographic Diagnostics
Microchips
MLS Laser Therapy
Modified Vaccine Protocol
>
Titers & Medical Exemption Letters
Stance Analysis
Surgery
Ultrasound, Echo & Endoscopy with Dr. Ludlow
Wellness - Preventative Care Plans
Client / Patient Center
Client Center
>
Annual Client Form & Hospital Policies
Pet & Pet Parent Social Media Agreement
Payment Options
Patient Center
>
Pet Information
Pre-Visit Questionnaire (PVQ)
Behavior Questionnaires
Admit & Anesthesia Release
Admit & Non-Anesthetic Release
Fear Free
Contact
Resources
Blog Center
A 10-year reflection
Acupuncture & TCVM A Natural Approach to Pain Relief? Pain
Rosie's Story
Ear cleaning with Dr. Couch
Separation Anxiety in Dogs
COVID-19 and the Effects on East-West Animal Hospital and the Veterinary Community
Healthy Mouth, Healthy Pet
Grain-free diets and your dog
Vaccines and your pet
Puppy Strangles
Pruritis: Itching and scratching in dogs
Fear Free Fun Visits!
Pet Insurance
Hills recalling can dog food
Cat Friendly Festivities