618-750-PETS(7387)
hello@villagevetpet.com
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Pet Pre-Visit Questionnaire Form

Thank you for choosing Village Veterinary Hospital. Please fill out the form as completely and accurately as possible.

Pet Pre-Visit Questionnaire Form

If you have any questions, please contact our team at Village Veterinary Hospital.

Name *

First

Last

Phone

Email *

Pet Information

Pet's Name *

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

Comments

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?

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:

Anything else you would like us to know?

Ready to Visit?

We Know Pets Are Family

Let us show you how we can make veterinary visits less stressful, more engaging for the entire family, and fear-free. We are here to help with your pet throughout your journey together.

Schedule Appointment

Questions?

Get in touch! We look forward to hearing from you.

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Location

2533A Vandalia St.
Suite B
Collinsville, IL 62234

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Contact Information

Email: hello@villagevetpet.com
Phone: 618-750-PETS (7387)

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Hours

Monday – Friday: 8:30 am – 5:30 pm

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First

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Email *

Phone

How can we help you? *

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We Proudly Serve the Pets of the Collinsville, IL Area, and Surrounding Towns in the MetroEast Area

Maryville, IL
Glen Carbon, IL
Edwardsville, IL
Troy, IL
Alton, IL
Godfrey, IL

O'Fallon, IL
Marine, IL
St. Jacob, IL
Highland, IL
MetroEast St. Louis

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