Separation Anxiety Dog Survey

Filing out this form completely will help our SA Specialist determine the most effective and efficient treatment plan for you and your dog.

Make sure to answer ALL of the questions fully and honestly. We are not here to judge you. The more accurate the information you provide, the better your results with us will be.

If you have multiple dogs but not all of them have Separation Anxiety (SA), please answer the questions below for the dog(s) with SA only.

Separation Anxiety Dog Survey
Dog 1 has separation anxiety
Dog 2 has separation anxiety
Dog 3 has separation anxiety
Dog 4 has separation anxiety
Add details for additional dogs in the Other Comments box below
What are your dog’s Separation Anxiety symptoms:
Do you have a home security / video monitor system

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