Survey for Caregivers Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.I support someone who requires an assistance dog YesNoSorry, but this survey is for supporters of people who require an assistance dog only. If you have any questions please email info@dogguides.com Indicate your province/territory *AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaOntarioPrince Edward IslandQuebecSaskatchewanNorthwest TerritoriesNunavutYukonIndicate your postal code *Age *17 or under18 to 2425 to 3435 to 4445 to 5455 to 6465 or overType of assistance dog used by the person you support: *Service/physical accessibility needsDiabetes AlertSeizure ResponseAutism AssistanceCanine VisionHearingHow long have you supported someone with an assistance dog? *less than a yearless than 5 yearsmore than 5 yearsmore than 10 yearsHow has the assistance dog positively impacted you (choose all that apply)?Less daily stress/worry about the person I care forLess worry aout the future for the person I care forReduced medical eventsLess reliance on me for daily needsImproved emotional and/or mental wellbeing overallImproved sleepmproved self-care (e.g. exercise, healthy eating habits, engage socially) was code barriers Other (please specify)Has adding and assistance dog for the person you care for contributed to your ability to (choose all that apply):Start or continue paid employmentIncrease hours of paid employmentTake less time off from paid employmentStarted or increased time volunteeringOther (please specify) *Has having an assistance dog (choose all that apply) Reduced trips to the emergency roomReduced trips to your health care provider (e.g. doctor, nurse practitioner, nurse)Reduced hospital staysReduced home care needsOther (please specify) *Have you noticed any changes in your emotional or mental well-being since your loved one was matched with an assistance dog?Significantly positive impactSomewhat positive impactNo impactOther (please specify)In what ways has your loved one’s assistance dog impacted your emotional or mental health?Decreased feelings of stress or anxiety.Decreased feelings of depression or sadness.Decreased feelings of social isolation.Improved self-esteem or confidence.Other (please specify)Have you encountered any barriers with the person you support to accessing businesses or public spaces because of the assistance dog? YesNoWhere have these barriers occurred? (choose all that apply)Public Transit (e.g. bus, train, subway, street car)Ride-Share (e.g. Uber, Lyft)TaxiAirportHealth care setting (e.g. hospital, clinic, doctor’s office)Education setting (e.g. school, campus)RestaurantsStores/Shopping CentresParagraph TextSubmit
