Location
*
Please Select
Annapolis
Hunt Valley
Owner Information
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Pet Information
Pet's Name
*
Species
*
Dog
Cat
Does your pet show reluctance to getting in the carrier or car?
*
Yes
No
Unknown
When going to the vet, how does your pet react?
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Eagar and excited
Reluctant
Subdued
Vocalize (barking, whining or meowing)
Try to hide
Drool
Pant
Vomit
Tremble
Urinate/defecate
Other
Does your pet have any known fears/anxieties or past trauma?
*
How active is your pet?
*
Very active
Moderately active
Mostly inactive
Couch potato
Check any situations listed below that your pet has shown avoidance or dislike of in the past.
*
Getting in their carrier or the car
Entering the hospital
Other pets passing by
People approaching them
Veterinary staff approaching them
Getting on the scale
Going into the exam room
Hearing door bells, phones ringing, or intercoms
Sounds coming from behind a door
Being placed on the table for examination
Direct eye contact
Loud voices or noises
Having temperature taken
Listening to heart or looking in their ears
Does your pet have any sensitive areas that they do not like to have touched? (Head, paws, tail, etc.)
*
What food does your pet eat? How much and how often do you feed?
*
What are your pets favorite treats? You may bring them to the exam - just remember not to offer any until the doctor approves. Patients must remain fasted through the exam and diagnostics.
*
Does your pet have any favorite toys? You may bring them to the exam - just remember to keep them hidden until the doctor or nurse approves their use. We need them to remain calm through the exam and diagnostics.
*
Is your pet reactive to any noises? (Loud voices, fireworks, clapping, etc.)
*
Yes
No
Are you a robot?
*
Submit
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