Separation Anxiety And Noise Phobia/Reactivity Questionnaire

The first set of these questions deals with an “actual absence”-the client actually leaves the house and the dog is either alone or totally without the client. The second set deals with “virtual absence”-the client is home, but not accessible because the door is closed, or the
dog is barricaded in another room. The questions are the same for each, but please answer both. Check NO if the dog does not react in the listed circumstance. Check UNKNOWN if you don’t know. Check YES if the dog reacts. Please evaluate the extent of the reaction from the list below.

1. Behaviors during an ACTUAL absence

2. Behaviors during a
VIRTUAL absence

3. Reactions to NOISE

Aggression Questionnaire

Previous Treatment Questionnaire

This questionnaire is designed to help us evaluate any role previous treatment may play in either your dog’s problems or in their resolution. We would like you to answer two types of questions. The first set focuses on general, global approaches recommended. The second set, which is a fairly lengthy tick list, focuses on specific actions recommended. Please complete these tables to the best of your ability, and if our lists are not complete, or you feel that an explanation is warranted, please complete the “comment ” section at the bottom. Even if you think that your dog is problem-free it would be extraordinarily helpful if you also completed this questionnaire so that we can compare dogs with problems to dogs without problems. Thanks!