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Closed Deaf Dog Survey
All of the questions (in black) are required. Make sure to answer all of these before you submit the finished form (in some cases, you may need to mark N/A - not applicable). All the other questions in brown are optional. Only answer these questions if they apply to your situation/experience.
(If you answer "Yes" to any of the questions regarding dog bites or aggression, we may want to follow up with you later to get the facts regarding the incident.)
Something About You ...
Owner's name:
First: Last:
E-mail address:
Had you owned other HEARING dogs before adopting your deaf dog?
Yes
No
Had you trained other HEARING dogs before training your deaf dog?
Yes
No
Did you have previous experience with a DEAF dog prior to owning this DEAF dog?
Yes
No
Did you know your dog was deaf when you adopted it?
Yes
No
How old was your dog when you determined it was deaf? (Please say "Unknown" if you do not know.)
Did you get help from a professional trainer in training your DEAF dog?
Yes
No (If "No" please mark N/A on the next question.)
If so, did that trainer have prior experience with DEAF dogs?
N/A
Yes
No
Unknown
In training your deaf dog, did you use a: (Check all that apply.)
shock collar?
invisible fence?
vibrating collar?
Something About Your Dog ...
Dog's name
(Dominant) Breed:
Age (Approximate or at passing):
(please specify
months or years)
Gender:
Male Female
Spayed or Neutered?
Yes Not Yet
Dog's age when adopted by you:
(please
specify months or years)
Deceased?
Yes No
My dog is
Bi-laterally Deaf (deaf in BOTH ears)
Unilaterally Deaf (deaf in ONE ear)
My dog lost it's hearing due to
Congenital (deaf at birth)
Old age
Injury or other trauma
Illness, medication or surgery
Unknown
My dog knows
hand signals/commands (number of hand signals)
My dog has the following titles and/or certifications:
More About Your Dog ...
Does this dog have a history of abuse or neglect?
Yes No Unknown
Has your dog ever been hit by a
car?
Yes No Unknown (If "No" or "Unknown"
please mark N/A on the next question.)
If you answered "Yes", did the dog
survive the encounter?
N/A Yes No
Normal Behavior Issues: Which (if any) of the following have you experienced with this dog? (Check all that apply.)
Chewing
Digging
Excessive Barking
Separation Anxiety
Difficult to house train
Jumping on people
Jumping on furniture
Abnormal Behavior Problems: Which (if any) of the following have you experienced with this dog? (Check all that apply.)
Compulsive shadow chasing
Compulsive licking
Compulsive tail chasing/spinning
Seizures (epileptic or other)
Seizure-based aggression
Other (Please specify)
Would you say that your dog is startled each day by normal events (such as tasks you perform around the house, unexpected movement, visitors, lights turning on, etc.)?
Frequently
Occasionally
Never
When you wake your dog from sleep is he or she:
startled?
Yes
No
Sometimes
frightened?
Yes
No
Sometimes
aggressive?
Yes
No
Sometimes
does he/she bite?
Yes
No
Sometimes
Other (Please specify)
My dog dislikes (i.e., is fearful of, avoids, becomes nervous, etc.) (Check all that apply.)
Strangers
Children
Other dogs
Cats
Vet
Other (Please specify)
My dog responds aggressively to (i.e., growls, barks, snaps, chases, etc.) (Check all that apply.)
Strangers
Children
Other dogs
Cats
Vet
Other (Please specify)
More Behavioral Questions ...
Has your dog ever been accidentally startled?
Yes
No
(If "No" please mark N/A on the next 2 questions.)
In response to being accidentally startled, did the dog respond aggressively?
N/A
Yes
No
In response to being accidentally startled, did the dog bite?
N/A
Yes
No
Have YOU ever tripped over, or otherwise startled, your sleeping dog?
Yes No
(If "No" please mark N/A on the next 2 questions.)
In response to being tripped over, did the dog respond aggressively?
N/A
Yes
No
In response to being tripped over, did the dog bite?
N/A
Yes
No
Has a CHILD ever tripped over, or otherwise startled your sleeping dog?
Yes No
(If "No" please mark N/A on the next 2 questions.)
In response to being tripped over, did the dog respond aggressively?
N/A
Yes
No
In response to being tripped over, did the dog bite?
N/A
Yes
No
Has your dog ever bitten a person?
Yes
No
Unknown
Has your dog ever attacked a person?
Yes
No
Unknown
Your Final Thoughts ...
Training my deaf dog was:
Pretty easy and/or no more difficult than training a hearing dog
Difficult at first, but became progressively easier
Very difficult
My dog is not trained
Would you knowingly adopt another deaf dog?
Yes
No
Maybe
Would you encourage others to adopt a deaf dog?
Yes
No
Maybe