Welcome to the Sounds Sensitivity Questionnaire brought to you by Ceva and Langford Vets

Your name:

Name of your dog/breed/age

Telephone:

Email address:

Nearly 50% of dogs are afraid of loud noises, such as fireworks, but some are more severely affected than others.

To find out how severely affected your dog is, just complete this simple 5-minute questionnaire.

Please hand this to reception and you will receive a personalised report and some simple tips on how to help your dog.

Base your answers to the following questions on your memory of the last time that your dog was exposed to fireworks or thunderstorms

(e.g. during the last thunderstorm or firework display)

1) Please tick one option. Regarding the minimal intensity for these sounds to provoke a response:

a) My dog reacts to sounds that I can hardly hear ¨

b) My dog reacts to sounds that I can hear but are not annoying ¨

c) My dog reacts to sounds that would startle anybody ¨

d) My dog reacts to sounds that nobody could stand ¨

e) My dog is never afraid of noises ¨

2) Rate the prominence of each of the following physical signs in your dog when it is in presence of loud noises (please tick one box for every section)

Very Much / Quite a lot / Moderately / Somewhat / Just a little / Not at all
Trembling
Panting
Salivation
Vomiting
Urination
Defecation

3) Rate the prominence of each of the following behaviours in your dog when it in the presence of loud noises.

Please tick one box for every section

Very much / Quite a lot / Moderately / Just a little / Not at all
Restlessness and pacing around the house
Running around the house
Destructiveness
Tries to hide somewhere in the house (i.e. under the sofa, in a dark room)
Crouches its body with ears back and tail between legs
Freezing

4) How does your dog react after a firework or thunderstorm event has ended? Please tick one option which is best suited to your dog.

a) shows restlessness and anxiety for the rest of the day and even the day after¨

b) shows restlessness and anxiety for the rest of the of the day ¨

c) shows restlessness and anxiety for at least 30-60 min ¨

d) shows restlessness and anxiety just for a few minutes ¨

e) shows calm behavior ¨

5) Some dogs seem to anticipate a fearful event and, when they do it, they change their usual behaviour.

What can you tell us about your dog? (Please tick one box in each section)

Very much / Quite a lot / Moderately / Somewhat / Just a little / Not at all
shows anxious behaviour on cloudy days
shows anxious behaviour when it starts raining