New Client Registration Form – Middleton

Your personal details

Your title

Your first name

Your surname

Address Line One

Address Line Two

Address Line Three

City or Town

Postcode

Your email

Your mobile

Consent to send medical reminders and info via text and email

Your pet's details

Name

DOB

Species

Breed

Sex

Neutered YESNO

Colour

Is your pet insured? YESNO

If YES, who is your pet insurance with?

Do you have more than one pet you would like to register? YesNo

If YES, how many pets would you like to register with us?

How did you hear about us?

Please tick an option Google SearchFacebookRecommendationLocal knowledgeOther

Any other comments...

FEAR FREE - Understanding your pet

Here at Harrison Family Vets, we really do believe that Pets are family. We know all too well that some pets find the trip to the vets incredibly stressful and fear inducing, with some of our own pets feeling that way too! We also know how upsetting and stressful it is for you as their pet parent to put them through these visits, so we are committed to finding a way in which this fear, stress and anxiety can be reduced for all involved!
Therefore, we want to understand your pet as if they are a member of our family; we have a few more questions we would like you to complete before your visit that covers their likes and dislikes.

FEAR FREE Questionnaire (optional)

What score out of 5 (1 being happy and excited, 5 being extremely fearful) would your give your pet when they visit a veterinary practice? 12345

Are there any veterinary procedures your pet does not like? e.g. nails being clipped, ears examined or temperature taken?

Does your pet get stressed and anxious around other pets in the waiting room? YesNo

Does your pet get nervous with new people or are they simply happy to be given lots of treats and fuss from anyone?

What are your pet’s favourite treats and toys?

Are there any parts of the body that your pet does not like being touched?

Has your pet ever been prescribed anti-anxiety medications or anti-nausea medications in the past? If so, how did your pet react to the medications?

How does your pet travel to the vets? Do they travel well or do they show signs or fear, anxiety and stress e.g. drooling, panting or passing urine or faeces. Do they get car sick?

Are there any commands that your pet is responsive to? (Sit/Stand/Wait/Down)

Is there anything else you feel we should know about your pet?

Please prove you are human by selecting the cup.