Pet Behavior Questionnaire -

Pet Name(Required)

Owner Name(Required)

First Last

Breed

Species

Approximate age

Sex

Please take a moment to complete the following questions. It is important to be honest with the answers so that we can provide a comfortable and safe environment for your pet and a positive experience for you and your pet.

Has your pet had a rabies vaccine?(Required)

Yes

Rabies vaccination expires:(Required)

If yes, when was it last administered?

At what age did you acquire your pet? (day, year & month if known)

Do you perform routine grooming at home on your pet?

If yes, then please provide tips and tricks that worked well for you. If not, why?

Have you had to give any medications to your pet?

If yes, were they pills, liquids, injectables? Did you experience trouble administering the medications?

Are there areas on your pet that are more sensitive than others?

If yes, please explain which areas and how pet reacts to different stimulants.

Does your pet suffer from separation anxiety?

If yes, are they on medication?

Does your pet suffer from noise phobia?

If yes, what works to help soothe them?

Does your pet have “stranger danger” or are they reactive to new people by barking or growling at them?

If yes, how do you handle this?

Has it been suggested that your pet have calming medications prior to any exams or visitations to the veterinary office?

If yes, which medications have you tried? How well did they work?

Has it been suggested to you that a house call veterinarian may work better for your pet?

How would you feel if the veterinary staff requested that a muzzle, an e-collar, or sedation be used to handle your pet?

Our priority is the safety of our staff, patients, and clients. We work hard to ensure that your visit is stress free and comfortable for you and your beloved family members. If advanced restraint techniques are necessary to assure the safety of all parties involved, we will council you ahead of time. Please be advised that you may refuse advanced restraint techniques during your visit; understand that doing so may limit our ability to provide proper care to your pet. We reserve the right to refuse services to any client/patient who we feel poses a threat to the general well-being of any individual. Thank you in advance for your understanding.(Required)

I have read and accept the statement above

I have read and decline the statement above

Email(Required)

** We reserve the right to refuse service should your pet become aggressive enough to put self or our staff at risk for injury. ***An additional fee may apply if sedation is needed to safely handle your pet or if multiple nurses are necessary to handle your pet.

Signature(Required)

95694

Pet Behavior Questionnaire

Please take a moment to complete the following questions. It is important to be honest with the answers so that we can provide a comfortable and safe environment for your pet and a positive experience for you and your pet.

Contact Us

Hours

Affiliate Clinic

Pet Behavior Questionnaire

Please take a moment to complete the following questions. It is important to be honest with the answers so that we can provide a comfortable and safe environment for your pet and a positive experience for you and your pet.

Contact Us

Hours

Affiliate Clinic

Contact Us

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P: 407-323-9743

F: 407-323-9932

Email Us

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