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"
No- but I would be willing to travel to participate
No- but keep me updated about online/remote participation opportunities & updates
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.
(area code) ### - ####
How many dogs do you currently own?
5 or more
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?
Less than 4 months
Between 4 months and 1 year
Was/Is this dog...
Check all that apply (if known)
Obtained from a breeder
Obtained from a shelter
A trained working dog
Primarily an indoor dog
Primarily an outdoor dog
What kind of training has your dog had?
Intermediate or advance obedience
Herding, hunting or livestock guarding
Unknown training history
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".
This dog has no known health problems
This dog is current on its vaccinations (including rabies)
This dog has never shown aggression towards humans
Anything else we should know about your dog?
Would you like to add more dogs?
No, I am done!
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service