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Veterinary Patient Intake & Symptom Screening Survey

A short pre-visit intake for veterinary clinics that captures pet basics, visit reason, and recent symptom changes before the appointment, with an AI follow-up that reconstructs the timeline and severity of the primary concern so the vet walks in prepared instead of starting from scratch.

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Sample questions

A preview of what’s in the template. Every question is editable before you launch.

13 questions · ~7 min
Q01
Message

Welcome! This quick intake helps your vet prepare before your pet's appointment. It takes about 7 minutes and covers basic info, the reason for today's visit, and any recent changes you've noticed.

Q02
Short TextRequired

What is your pet's name?

Q03
Multiple ChoiceRequired

What type of animal is your pet?

  • Dog
  • Cat
  • Bird
  • Rabbit
  • Reptile
Q04
Short Text

What breed is your pet, if known?

Q05
NumberRequired

How old is your pet, in years? Enter 0 if under one year old.

Q06
Multiple ChoiceRequired

Is this an existing patient at our clinic, or is your pet visiting us for the first time?

  • Existing patient
  • First-time patient
Q07
Multiple ChoiceRequired

What is the main reason for today's visit?

  • Wellness or annual checkup
  • Vaccination
  • Illness or injury
  • Follow-up on an existing condition
  • Behavioral concern
Q08
Multiple ChoiceRequired

In the last 7 days, has your pet had any change in appetite or thirst?

  • No change
  • Eating or drinking more than usual
  • Eating or drinking less than usual
  • Not eating or drinking at all
Q09
Rating ScaleRequired

How would you rate your pet's energy level over the last few days compared to normal?

Range: 1 – 5
Min:Much lower than normalMax:Much higher than normal
Q10
Long Text

List any medications, supplements, or treatments your pet is currently receiving (or write 'None').

Q11
AI Interview

Reconstruct the timeline of the primary concern for this visit, anchoring on the reason selected above: when it started, how it has changed (better, worse, or the same), what the owner has already tried, and how it's affecting the pet's daily behavior. If the visit reason is a routine wellness checkup, instead probe for any subtle changes the owner noticed but didn't think worth flagging (limping, scratching, mood, sleep). If the owner reports appetite or energy changes, get specifics on severity and duration rather than accepting vague descriptions.

Q12
Email

Best email to reach you if the clinic has a question before the appointment (optional).

Q13
Message

Thank you! This information goes straight to your vet's team so they can prepare for your pet's visit and make the best use of your appointment time.

What’s included

  • AI follow-ups

    Adaptive probes on open-ended answers that pull out detail a static form would miss.

  • Attention checks

    Built-in safeguards against rushed answers and low-quality respondents.

  • AI-drafted copy

    Wording, ordering, and branching written by the AI — tuned to your research goal.

  • Auto report

    Themes, quotes, and a plain-English summary write themselves once responses come in.

How it compares

We reviewed the closest templates from other survey tools. Here’s what they do well — and where this template goes further.

Why this template

  • Goes beyond static intake fields with an AI follow-up interview that reconstructs the timeline and severity of the primary concern, so the vet has context instead of a blank slate.
  • Captures the essentials fast — pet basics, new vs. existing patient status, visit reason, appetite/thirst changes, and energy-level rating — without turning the intake into a long form.
  • Includes a dedicated field for current medications/supplements/treatments, directly useful for clinical prep, plus an optional email for pre-appointment follow-up.
  • Uses plain-language chat messages to set expectations and thank the owner, keeping the experience approachable for non-technical pet owners.

SurveyMonkey

Veterinarian Patient Intake Template

This is a ready-to-field short-form template built specifically for veterinary patient intake, so it's a direct comparable. It covers standard intake basics but is a fixed-question form rather than an adaptive interview, meaning symptom detail depends entirely on how owners self-report.

What it does well

  • Purpose-built for veterinary intake rather than general healthcare
  • Backed by SurveyMonkey's established survey-building and distribution tools
  • Short-form design likely keeps completion time low

Where it falls short

  • Static question set with no adaptive follow-up to probe vague symptom answers
  • No mention of AI-driven timeline/severity reconstruction of the presenting concern
  • No transparent prompt methodology since it's a fixed template, not an AI interview

SurveySparrow

Veterinarian Patient Intake Survey Template

A veterinary-specific intake template that's genuinely comparable in scope and audience. It's built around SurveySparrow's conversational form style, but the conversational tone is scripted UX, not an AI system that dynamically follows up on individual answers.

What it does well

  • Veterinary-specific template with a conversational, chat-like presentation
  • Part of a broader healthcare template library, suggesting reusable design patterns
  • Likely mobile-friendly given SurveySparrow's conversational form focus

Where it falls short

  • Conversational styling is pre-scripted, not adaptive AI probing based on prior answers
  • No automated per-response quality scoring or auto-generated clinical-prep report
  • No voice AI interview option for owners who prefer speaking over typing

Ready to launch?

Open this template in the editor. Every part is yours to change before the first respondent sees it.

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