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Patient Personality Questionnaire

Pet Name

Your Name

First Last

Does your pet show fear, stress or anxiety when visiting the veterinary clinic?

Yes

Has your pet ever been prescribed supplements/medication for veterinary visits? If so, what kind and did it help?

Please select any of the following that cause your pet fear, anxiety, or stress:

Getting in the car/carrier

Loud noises

Waiting around other pets in the lobby

Being approached by veterinary staff

Eye contact with veterinary staff

Physical contact from veterinary staff

Getting on the scale

Entering the exam room

Being lifted to the exam table

Loud voices during examination

Having rectal temp taken

Use of instruments during examination

Being taken out of exam room for procedures

Sounds like phones ringing, doorbells, etc.

How is your pet around other animals?

Eager/excited

Reluctant

Fearful

Aggressive

How is your pet around other people?

Eager/excited

Reluctant

Fearful

Aggressive

Areas your pet is sensitive to during examination:

Ears

Eyes

Mouth

Nose

Neck

Chest

Stomach

Back

Front Legs

Back Legs

Paws

Tail

Rump

Rectum

Genitals

None

Procedures that are stressful for your pet (nail trims, anal glad expression, temperature, etc.)

Does your pet have favorite treats? If so, what kind?

Does your pet have favorite toys?

Is there anything else you’d like us to know?

CAPTCHA

Phone

This field is for validation purposes and should be left unchanged.

(541) 241-3121

1350 SE Reed Market Rd.
Suite #202
Bend, OR 97702

Mon-Fri: 8:00 am - 5:00 pm

Emergency Info:
Bend Animal Emergency and Specialty Center
Veterinary Referral Center of Central Oregon

Online Pharmacy

Request an Appointment

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