Sandy and Patrick are laughing together.
Sandy thanks Patrick for helping her with one of her inventions.
Sandy gives Patrick tips on making a game. Later, he invites her, SpongeBob, and Squidward to play it. She enjoys playing Patrick's game and occasionally scolds Squidward whenever he gets mad at him.
After finding out Squidward created a sport that was meant to kill SpongeBob and Patrick, she stands up for her friends and challenges Squidward to a game in order to save them from death. Sandy manages to win the game and SpongeBob and Patrick are saved.
Patrick attends Sandy's birthday party and sings "Happy Birthday" to her alongside her friends.
Times they have fought
After Sandy knocks on SpongeBob's door to take him to the doctor but is told that he is not home, she walks over to Patrick's house and realizes that he has a new home, which has SpongeBob's feet sticking out and essentially serves as his disguise. When Sandy demands an answer as to where SpongeBob is, Patrick tells him he is not available at the moment and to leave a message after the "beep," but Sandy does not want to play games with him as SpongeBob is in a very serious situation. She then grows suspicious of the second house being SpongeBob in disguise, which is then revealed to be true as SpongeBob sneezes and thus destroys the second house.
They then get into a fight over whether or not SpongeBob should go to the doctor. Patrick protests the idea on account of hospitals being "scary" places and resorts to treating SpongeBob through pretend medicine, but Sandy tries to get him real help immediately due to the severity of the suds condition SpongeBob has. Sandy berates Patrick and states that he should be arrested for impersonating a doctor, while Patrick thinks that he was doing a good job and it was unnecessary of Sandy to show up.
Patrick makes fun of Sandy's home state, Texas along with SpongeBob, and the people who live there, angering Sandy to the point where she chases him, lassoes him to her rope, and then beats him up so violently it causes a nuclear explosion.
Patrick kicks Sandy after Squidward recommends his band does some kicking and Sandy responds by sticking him in a trombone. When he kicks her again later in the episode, she tries to do the same with a trumpet.
When Patrick instructs SpongeBob to land on his other bottom, Sandy asks him "Don't you have to be stupid somewhere else?" Later, Sandy hits Patrick on the head when he shows her what crazy talk is.
Patrick, after obtaining sudden intelligence, calls Sandy dumb, correcting her math and assuming that people younger than her could do better. This makes her upset, kicking him out and calling him a "barnacle head," stating that she liked him better when he was an idiot.