Your Name

Your Pet's Name

How does your pet behave during travel in the car? (Check all that apply)
Happy/Enjoys the RidePaces/PantingLays Down/ComfortableOther

If Other, please describe:

Does your pet show any signs of nausea with car travel?
YesNo

If Yes, please describe the signs of nausea:

How do you describe your pet's reaction to entering the veterinary hospital? (Check all that apply)
Happy/Enjoys the EnvironmentPaces/PantingDoes not like to interact with other dogsDoes not like to interact with people

What are your pet's favorite treats? (Check all that apply)
CheesePeanut ButterStore-Bought TreatsOther

If Store-Bought or Other, please describe your pet's preferred treats:

Does your pet enjoy getting on the scale for weight measurement?
YesNo

Does your pet have any sensitive areas where he/she does not like to be touched or examined by you or others? (Check all that apply)
EarsFace/Teeth/EyesFeetTail/Rear EndOther

If Other, please describe:

How does your pet react to exiting the hospital?
Happy/Enjoys LeavingReluctant to LeaveNo Preference

How does your pet behave upon re-entering the home and/or upon re-introduction to home with other pets? (Check all that apply)
Happy/Smooth ReturnHidesOther pet(s) will not leave him/her aloneOther

If Other, please describe:

Please share any additional information you would like us to know: