Attachment and Oxytocin Dog Participant Questionnaire
If you wish to be considered for a study exploring the effects of nasally-administered oxytocin on attachment behavior, please answer a few questions about you and your dog(s) below. This information will only be used to assess your dog’s eligibility for participation in upcoming studies and to keep you informed about participation opportunities and updates.
Filling out this information does not automatically enroll you in a study (we will always provide you with more details and obtain your formal consent before considering you or your dog an active participant).
Your first name *
Your last name *
Do you live within an hour of Corvallis or Eugene Oregon? *
We will try to limit communications about ‘local’ participation opportunities to those who check "Yes" or "No + travel"
Email address *
We will only use the contact information you provide to let you know about participation opportunities, updates, or to schedule appointments. Such communications will not be frequent (i.e. maybe one email per month). However it is important to have some way to contact you if you do decide to participate in an upcoming study.
Phone number
(area code) ### - ####
How many dogs do you currently own? *
Would you be willing to bring your dog(s) in for testing two separate times? *
For this study, we are comparing results on an attachment test in which the same dog receives saline on one visit, and oxytocin on a separate visit, so we ask that each dog participates in this study twice.
Basic Dog Information
What is your dog's name? *
If you have more than one dog, choose one for now. You will be given an option to add additional dogs after submitting this form
What is your dog's breed? *
If unknown write: "mix"
What is your dog's sex? *
Is your dog spayed or neutered? *
How old is your dog (In years, months)? *
Use the true/estimated age you use at your vet's office.
How long have you owned your dog? *
Was/Is this dog... *
Check all that apply (if known)
Required
What kind of training has your dog had? *
Required
Does your dog currently have separation anxiety, or have a history of separation anxiety? *
Including excessive barking/howling, destroying objects in the home and/or distress when left alone?
If you answered yes to the above question, "Does your dog currently have separation anxiety, or have a history of separation anxiety?", please describe.
Please check each item if true. *
If you leave any of these boxes unchecked, please explain why under "other".
Required
Anything else we should know about your dog?
Would you like to add more dogs? *
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