SURVEY QUESTIONNAIRE

FROM: HUMAN CANINE RELATIONSHIPS

Personal Information:
Name (optional): __________________ Age: ______ years old

Gender: Male______ Female______ Grade & Section:________________

I. Please answer the following questions honestly.

Encircle your answer.

1. How would you describe the environment in 12. How many hours do you work/study?
which you live?
a. Do not work.
a. Urban/city environment
b. Less than 35 hours.
b. Rural/country environment
c. Between 35 to 45 hours a week.
c. Suburban/Residential environment
d. More than 45 hours a week.

2. What type of activities do you prefer, in general? 7. How would you rate your knowledge of the needs
and behavioral characteristics of the breed that you
a. I enjoy mostly energizing activities.
own before obtaining the dog?
b. I enjoying mostly relaxing activities.
a. I knew the breed’s general needs and character
very well.
3. Where do you like to spend most of your time?
b. I knew some things about the breed’s general
a. I like being indoors the most. needs and character.
b. I like being outdoors the most. c. I knew a little about the breed’s general needs
and character.
4. How many dogs do you own? d. I knew almost nothing about the breed’s general
__________________ needs and character.

5. What breed of dog(s) do you own? Please 8. How would you describe the match between you
specify?____________________________________ and your dog?
___________________________________________
a. We are a perfect match.
___________________________________________
b. We are a near perfect match.
6. How would you describe the primary reason for c. We generally are a good match.
obtaining your dog?
d. We generally are not a good match.
a. I obtained my dog for his/her appealing
appearance. e. We are not a good match.

b. I obtained my dog for his/her appealing

character. 9. How would you describe your dog’s energy level?

c. I obtained my dog for protection. a. My dog has a very high level of energy.

d. I obtained my dog for companionship. b. My dog has a high level of energy.

e. I obtained my dog for an exercise/recreation c. My dog has an average level of energy.

partner. d. My dog has a low level of energy.
f. I obtained my dog for showing.
g. I obtained my dog for breeding. 13. How often do you take your dog for a walk?
h. Other a. I walk my dog every day.
b. I walk my dog a few times a week.
c. I walk my dog a few times a month. II. Encircle the response which best reflects your
opinion
d. I rarely walk my dog.
e. I never walk my dog.

Check the box for each statement which best Rarely or Some or a Occasionally Most or all
describes how you felt or behaved DURING THE none of the little of the or a moderate of the time
PAST FEW WEEKS. time (Less time amount of
(5-7 Days)
than 1 Day) the time
(1-2 Days)
(3-4 Days)

1. House canines add happiness to my life

14. How would you describe the experience of
Strongly agree Agree
walking your dog?
Disagree Strongly disagree
a. I never walk my dog.
b. It is always a pleasant experience to walk my
2. I love canines.
dog.
Strongly agree Agree
c. It is usually a pleasant experience to walk my
dog. Disagree Strongly disagree
d. It usually is not a pleasant experience to walk
my dog. 3. I frequently talk to canines.
e. It is rarely a pleasant experience to walk my dog. Strongly agree Agree
Disagree Strongly disagree
15. How would you describe your dog’s playfulness?
a. My dog wants to play all the time. 4. I would like a canine in my home.
b. My dog likes to play sometimes. Strongly agree Agree
c. My dog does not like to play. Disagree Strongly disagree

16. How often does your dog want attention? 5. In general, how would you say your mental health?
Excellent Very Good Poor
a. My dog wants attention constantly.
Good Fair
b. My dog enjoys attention, but he/she does not
want it constantly.
c. My dog only sometimes wants attention.
d. My dog does not ever want attention.

III. Check the box that corresponds to your answer.

During the past 4 weeks, how often did your physical or emotional health interfere with your normal social
activities with family, friends, groups or neighbors?
□ Often □ Sometimes □ Rarely □ Never
I was bothered by things that usually don’t bother
me.
I had trouble keeping my mind on what I was doing.
I felt depressed.
I felt that everything that I did was an effort.
I felt hopeful about the future.
I felt fearful.
My sleep was restless.
I was happy.
I felt lonely.
I could not get “going.”
I feel stressed and sad when I’m alone.

How often is each of the following support available to None of A little Some of Most of All of
you if you need it? the time of the the time the time the time
time (2)
(1) (3) (4) (5)
I have someone who shows me love or affection
I have someone to confide in or talk to about myself or
my problems
I have someone to get together with for relaxation
I have someone to do things with to help me get my
mind off things
I have someone to help with daily chores if I were sick
Someone to turn to for suggestions about how to deal
with a personal problem

Goal Orientation Always (4) Sometimes (3) Seldom (2) Never (1)
I work on things that has to be done first
I set deadlines to my future goals
I try to see the big picture before making a decision
I don’t rely on others
I don’t stop in just one goal and continue to improve
myself by aiming higher.
I have someone to take me to the doctor if I needed it.

Check the box for each question which best Almost Often Sometimes Almost
describes your relationship with your CURRENT Always Never
(3) (2)
canine(s).
(4) (1)
My canine is aware of my different moods.
I play with my canine when he/she approaches.
I prefer to be with my canine more than with most
people I know.
When I feel bad, I seek my canine for comfort.
I feel sad when I am separated from your canine.
I talk to my canine about things that bother me.
My canine gives me a reason for getting up in the
morning.
My canine is a member of our family.
In many ways my canine is the best friend I have.
My canine helps me to be more physically active
My canine helps me unwind and clear my thoughts.
I feel happy playing with my canine
I feel great after hanging out with my canine.

Academic Performance and School-Related Stress Always (4) Sometimes (3) Seldom (2) Never (1)
I feel stressed with too much school works
I feel stressed and sad when my grades are low
I meet the deadline of my school works
I participate in my class as much as I can
I study things thoroughly and seriously
I don’t have failing grades
I excel in class
My canine helps me in overcoming stress in school
 Thank You for your help
in this Survey!
Farewell Bitches!!!

Time Management Always (4) Sometimes (3) Seldom (2) Never (1)
I make checklists for my daily plans
I don’t have problems balancing canine ownership
and school related works.
I tend to be productive during my free time
I don’t’ waste my time on unnecessary things