Canine Anxiety Assessment Survey
Help us understand your dog's anxiety symptoms and behaviors for better support and care.
Owner Full Name
*
First Name
Last Name
Owner Email Address
*
example@example.com
Dog's Name
*
Dog's Age (in years)
*
Dog's Breed
Dog's Sex
*
Male
Female
Other/Unknown
How often does your dog display the following anxiety-related behaviors?
*
Rows
Never
Rarely
Sometimes
Often
Always
Pacing or restlessness
1
2
3
4
5
Panting or trembling without physical exertion
6
7
8
9
10
Excessive barking or whining
11
12
13
14
15
Destructive behavior when left alone
16
17
18
19
20
Attempts to escape or hide
21
22
23
24
25
Loss of appetite during stressful events
26
27
28
29
30
How severe are your dog's anxiety symptoms overall?
*
Not severe at all
1
2
3
4
5
6
7
8
9
Extremely severe
10
1 is Not severe at all, 10 is Extremely severe
Which of the following situations seem to trigger your dog's anxiety? (Select all that apply)
*
Separation from owner
Loud noises (e.g., thunder, fireworks)
Strangers or unfamiliar people
Other animals
Car rides or travel
Veterinary visits
Changes in routine/environment
Other (please specify)
How long have your dog's anxiety symptoms been present?
*
Less than 1 month
1-6 months
6-12 months
Over 1 year
Have you previously tried any interventions or treatments for your dog's anxiety?
*
Yes
No
If yes, please describe any interventions or treatments you have tried and their effectiveness.
Is there anything else you would like to share about your dog's anxiety or behavior?
Submit Assessment
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