Pre-Visit Client Questionaire

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Fear Free

Our Mission Statement

Littlestown Veterinary Hospital is dedicated to bringing compassionate, comprehensive care to everyone in our community. We adhere to the principles of the Fear Free initiative and strive to serve our patients with the best medicine available. With our Fear Free and low-stress knowledge and techniques, we seek to enhance the lives of all those we encounter - patients, clients, and employees.

Pre-Visit Client Questionnaire and Interview

As a Fear Free Certified Professional team, we want to make your pet's veterinary experience as enjoyable and 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.
Please note we are NOT accepting new clients at this time, this is NOT a new client form.

* Indicates required field

Owner Name *

First

Last

[object Object]

Pet Name(s) *

Preferred contact phone or email *

How would you describe your pet's reaction to going to the veterinary hospital? *

Eager and Excited Subdued Reluctant Somewhere in between

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 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 Having procedures done Being handled by staff Walking through the clinic

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? *

How would you describe your pet around other animals and people, such as in the lobby of the veterinary hospital? *

Does your pet have any sensitive areas that he does not like to have touched or examined 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 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 next visit to our hospital) *

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

Has your pet ever been prescribed any medications to help with a visit to the veterinary hospital? If so, please list below: *

Does your pet prefer: *

Female veterinary professionals Male veterinary professionals It doesn't matter

Anything else you would like us to know? *

Submit

LVH Employees

Littlestown Veterinary Hospital | 5010 Baltimore Pike, Littlestown, PA | Phone: 717-359-7877 | Fax: 717-359-4022
Website Design by Crawford Designs, LLC

Home
About Us
Fear Free
- About Fear Free
- Pre-Visit Client Questionaire
Services
Resources
- Diet
- Adoption
- Behavior
- Grief and Loss
- Other Links
- Videos
Emergency
PetDesk
Prescriptions
- Vet's FIrst Choice Online Pharmacy

Fear Free

Our Mission Statement

​Pre-Visit Client Questionnaire and Interview

Pre-Visit Client Questionnaire and Interview