Separation Anxiety QuestionnairePlease enter your email address:* Dog's first name:* Dog's last name:* How long has the dog been exhibiting this behavior? Do you know of any incident/change in routine that may have caused the behavior to start?Does this behavior occur every time the dog is left at home alone?If no, under what circumstances does the dog exhibit the anxious behavior? How long can the dog be left alone before exhibiting this behavior? When someone is not at home, how is the dog left?(check all that apply) Indoors, loose Indoors, confined to a room Indoors, confined to a crate Outdoors, loose in yard Outdoors, loose in dog run Outdoors, tethered Other If other, please explain:First When someone is home, the dog...(check all that apply) Follows household members around the house Insists on being in close physical contact with household member(s) at all times Will sleep, play with a toy or go outside, not taking notice of household members moving from one room to another Displays anxious behavior Reacts fearfully or anxiously to loud noises/thunder/fireworks Other If the dog plays anxious behavior, please describe the behavior:If other, please explain:When someone is preparing to leave the house, the dog...(check all that apply) Doesn’t react. There is only a problem when no one is home. Whines Paces Trembles Drools Vomits Pants profusely Barks Loses bowel control Other If other, please explain:If you noted that your dog has a reaction to you preparing to leave the house, please note what specific thing(s) causes your dog to react:(check all that apply) Putting on certain clothes (coat, shoes, etc.) Picking up keys Picking up purse/backpack/briefcase Putting dog in crate/confinement area Other If other, please explain:When left alone, the dog…(check all that apply) Pants/Paces/Won’t settle Drools Urinates/defecates in house/crate Vomits Barks/whines/cries/howls Chews/destroys items Injures themselves Escapes/tries to escape Other If they injure themselves, please explain:If they escape or tries to escape, where from?If other, please explain:If your dog has housetraining mistakes (urination/defecation) in the house, when do they occur?(check all that apply) Does not When someone is home When someone is not home Will the dog eat food or treats when left alone? Yes No If no: does the dog go and eat the food as soon as you get home? Yes No Have you tried crating the dog? Yes No If yes, what is the dog’s reaction to the crate when left alone?(check all that apply) Settles quickly Will settle if provided with toys/chews Drools in crate Cries/barks Defecates in crate Urinates in crate Has escaped the crate Will cause injury to himself trying to escape the crate. For how long? If they will cause injury to himself trying to escape the crate, please describe:Have you tried any other types of confinement? Yes No If yes, please check all that apply: Confined to one room of house Loose in the house Garage Loose in fenced yard Chained/tethered in yard None Other If other, please explain:Please describe the dog’s reaction to these forms of confinement, especially most and least successful:How does the dog react when you get home? Very happy but calms down fairly quickly Extremely excited, takes a long time to calm down Happy/excited, but anxious (panting, pacing, whining, etc.) Other If other, please explain:Have you seen a dog trainer, behaviorist, or veterinarian for this issue? If yes, please provide the name of vet and/or behaviorist/trainer. If they have seen a veterinarian, please list type of training and any diagnoses, medications, or recommendations given and the results:Is there any additional information you would like to add?