Owner Consent Form: Stress associated with veterinary visits involving blood draws in pet dogs

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Email *

What is your name? *

What is your dog's name? (You may list more than one if you have more than one dog you're volunteering to participate) *

Check all that apply: *

I am a current client of Clarendon Animal Care

My dog is between 2-10 years of age

My dog does not have any acute or chronic illness

My dog does not regularly take any medication other than flea/tick/heartworm prevention, allergy medication, or an NSAID (Rimadyl/carprofen)

My does does not take medication for fear, anxiety, and stress associated with veterinary visits

My dog has lived with me for at least 6 months

My dog is due for bloodwork (heartworm/4DX+ test, pre-operative bloodwork, chronic medication monitoring)

Required

If any boxes above are not checked, please explain. If all boxes are checked, write "n/a." *

Purpose of the research study:

The purpose of this study is to assess dogs’ physiological and behavioral response to stress experienced in the veterinary hospital when having blood drawn, and also to assess the validity of the Fear Free(™) Fear, Anxiety, and Stress (FAS) Scale.

Study overview:

Participation in this study requires commitment to collecting four (4) urine samples on three (3) consecutive days, Tuesday through Thursday. On Days 1, 2, and 3 you will collect a sample of your dog’s first morning urine. On Day 2 (Wednesday) you and your dog will come into the Clarendon Animal Care (CAC) South location for a technician appointment between 7:45 a.m. - 9:45 a.m. to have blood drawn. You will be escorted directly to an exam room where you’ll wait for 5 minutes to allow your dog to acclimate to the environment. A technician will then enter to fit your dog with a Polar human heart rate (HR) monitor and apply lidocaine/prilocaine cream to possible venipuncture sites. The technician will draw a blood sample while you +/- an assistant gently restrain and feed treats. The blood sample will be submitted to the lab for appropriate testing, you will be checked out, and then you will remove the HR monitor just before you and your dog depart. The next time your dog urinates after departing, you will collect a urine sample. Once you collect the final urine sample on the morning of Day 3, all urine samples need to be returned to CAC South.

I understand the purpose of this study and am willing and able to participate as described

I understand that I am financially responsible for my dog’s technician appointment fee and bloodwork costs. Blood is not being collected for research purposes, it is being collected as part of my dog’s routine wellness care.

I understand that I am NOT financially responsible for any urine sample collection supplies or sample analysis as these samples ARE being collected for research purposes.

Required

Media:

All visits will be video-recorded for post-visit evaluation and scoring of FAS. Recordings may be used for promotional, educational, or research purposes in the future and are the property of the researcher.

Risks and Benefits:

There are no risks to the dogs or pet owners participating in this study. Participation in this study may help benefit the future health and wellness of pet dogs.

Voluntary participation:

Enrolling the dogs in your custody in this study is completely voluntary. There is no penalty for not participating.

I understand and accept the above

Required

Right to withdraw from the study:

You have the right to withdraw your dogs from the study at any time without consequence.

Whom to contact if you have questions about the study:

Alyssa Cary, LVT, MS Student Researcher - Applied Animal Behavior and Welfare Lab, Virginia Tech, alyssa@fusionanimalbehavior.com

Erica Feuerbacher, Associate Professor of Applied Animal Behavior & Welfare, enf007@vt.edu

Whom to contact about any concerns regarding animal use and care in this study:

IACUC Office 300 Turner Street, Suite 4120 (0497), Blacksburg, VA 24060; iacuc@vt.edu
*

I understand and will contact the appropriate party if I choose to withdraw my dog(s) from this study, or if I have questions or concerns

Required

Agreement:

I have read the procedure described above. I voluntarily agree to allow my dog(s) named above to participate in the research and I have received a copy of this description. Typing my name below will serve as my electronic signature and acknowledgment of this agreement.

A copy of your responses will be emailed to the address you provided.

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