780-250-1700
2531 – 17th Street NW Edmonton, AB
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Fear Free Clinic
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Drop Off Consent Form – with sedation
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Blood Glucose Curve – Drop Off Consent Form
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Ultrasound Consent Form
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Feline Patient Admission Form
Recheck Exam Admission Form
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Diarrhea Questionnaire
Vomiting Questionnaire
Itching Questionnaire
Canine Cognitive Dysfunction Syndrome Assessment
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Pre-Visit Questionnaire
As a Fear Free Certified Professional team, we want to make you 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 your & your pet’s preferences.
Name
*
First
Last
Date
*
Date Format: MM slash DD slash YYYY
Pet's Name
*
Do your pets show any reluctance to getting in the carrier or car?
*
Yes
No
How and where does your pet travel in the car? (carrier, seatbelt, loose, etc.)
*
During travel to the veterinary hospital, does your pet do any of the following?
*
Eager & Excited
Subdued
Reluctant
Bark/Meow
Hide
Whine
Drool
Pant
Vomit
Tremble
Urine/BM
Pace
None
ctrl + click to select multiple
Does your pet prefer:
*
Female Veterinarian
Male Veterinarian
No Preference
Select 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
ctrl + click to select multiple
How would you describe your pet around other animals and people?
*
Does your pet have any sensitive areas that s/he does 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 trims, weight, temperature, ear exam, blood draw) If so, how did you 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 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?
*
Anything else you would like us to know?
*
Best number to reach you at during appointment time
*
Home
Contact
New Clients
What to Expect
New Client Registration Form
Prescription/Food Refill Request
About Us
Team and Pet Bios
Location & Hours
Make an Appointment
Fear Free Clinic
Services
Medical Services
Surgical Services
Anesthesia and Patient Monitoring
Nutritional Counseling
Additional Services
Pet Health
Pet Health Library
Pet Health Checker
How-To Videos
News
Forms
Consent Forms
General Anesthesia Consent
Euthanasia Consent Form
Echocardiogram – Drop Off Consent Form
Drop Off Consent Form – with sedation
Drop Off Consent Form
Overnight Hospitalization – Drop Off Consent Form
Blood Glucose Curve – Drop Off Consent Form
Dental Surgery Consent Form
Spay/Neuter Surgery Consent Form
Telemedicine Consent Form
Ultrasound Consent Form
Admission Forms
Canine Patient Admission Form
Feline Patient Admission Form
Recheck Exam Admission Form
Questionnaires
Diarrhea Questionnaire
Vomiting Questionnaire
Itching Questionnaire
Canine Cognitive Dysfunction Syndrome Assessment
Shop Online
Contact Us
Name
*
First
Last
Email
*
Phone
*
Pet Name
*
Preferred Date
*
MM
DD
YYYY
Preferred Time
*
:
HH
MM
AM
PM
Reason for appointment
*
