Survey for Clients Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Are you the primary handler of an assistance dog? *YesNoSorry, but this survey is for primary handlers 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 overWhat type of assistance dog do you use? *Service/physical accessibility needsDiabetes AlertSeizure ResponseAutism AssistanceCanine VisionHearingHow long have you had an assistance dog? *less than a yearless than 5 yearsmore than 5 yearsmore than 10 yearsTo what degree has your assistance dog had a positive impact on your ability to do the following? 0 = no impact or negative impact, 10 = significant/ life changing positive impact Live independently Rate 1 out of 10Rate 2 out of 10Rate 3 out of 10Rate 4 out of 10Rate 5 out of 10Rate 6 out of 10Rate 7 out of 10Rate 8 out of 10Rate 9 out of 10Rate 10 out of 10Engage more with family, friends, community involvement Rate 1 out of 10Rate 2 out of 10Rate 3 out of 10Rate 4 out of 10Rate 5 out of 10Rate 6 out of 10Rate 7 out of 10Rate 8 out of 10Rate 9 out of 10Rate 10 out of 10Pursue higher education Rate 1 out of 10Rate 2 out of 10Rate 3 out of 10Rate 4 out of 10Rate 5 out of 10Rate 6 out of 10Rate 7 out of 10Rate 8 out of 10Rate 9 out of 10Rate 10 out of 10Positive Social Interactions Rate 1 out of 10Rate 2 out of 10Rate 3 out of 10Rate 4 out of 10Rate 5 out of 10Rate 6 out of 10Rate 7 out of 10Rate 8 out of 10Rate 9 out of 10Rate 10 out of 10Start or continue paid employment Rate 1 out of 10Rate 2 out of 10Rate 3 out of 10Rate 4 out of 10Rate 5 out of 10Rate 6 out of 10Rate 7 out of 10Rate 8 out of 10Rate 9 out of 10Rate 10 out of 10Increase hours of paid employmentRate 1 out of 10Rate 2 out of 10Rate 3 out of 10Rate 4 out of 10Rate 5 out of 10Rate 6 out of 10Rate 7 out of 10Rate 8 out of 10Rate 9 out of 10Rate 10 out of 10Take less time off from paid employmentRate 1 out of 10Rate 2 out of 10Rate 3 out of 10Rate 4 out of 10Rate 5 out of 10Rate 6 out of 10Rate 7 out of 10Rate 8 out of 10Rate 9 out of 10Rate 10 out of 10Started or increased time volunteering Rate 1 out of 10Rate 2 out of 10Rate 3 out of 10Rate 4 out of 10Rate 5 out of 10Rate 6 out of 10Rate 7 out of 10Rate 8 out of 10Rate 9 out of 10Rate 10 out of 10Other (please specify) Having an assistance dog has (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 being matched with an assistance dog? Significantly positive impactSomewhat positive impactNo impactOtherIf Other (please specify) In what ways has your assistance dog impacted your emotional or mental health? Decreased feelings of stress or anxietyDecreased feelings of depression or sadnessDecreased feelings of social isolationImproved self-esteem or confidenceOther (please specify) what with an Have you encountered any barriers to accessing businesses or public spaces because of your 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 CentresOther [please specify]Anything else you’d like to share about the impact of having an assistance dog on your life:Submit
