Separation Anxiety Questionnaire

This questionnaire is intended as a tool to facilitate a conversation with a licensed veterinarian about certain unwanted behaviors you are experiencing with your dog. It is not a substitute for an accurate diagnosis from your veterinarian, who is your best source for information and advice about your pet's health.

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Problematic Behaviors

Please answer the following questions as best you can, then print the results to share with your veterinarian, if appropriate.

Does your dog…
Greet you excessively when you return home, even after a short separation?
Constantly try to maintain close contact with you at home, especially when you are preparing to leave?
Bark or whine excessively when left alone?
Try to escape from crates, enclosures or other confinement areas?
Become agitated or distressed when you prepare to leave?
Urinate or defecate in the house only when left alone?
Display destructive behavior only when left alone?
Exhibit any other unusual behaviors, such as pacing, drooling, vomiting, diarrhea, trembling, withdrawal, self-mutilation, refusal to eat, depression or lethargy?
Exhibit any other behavior you find unacceptable or would like to change?
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Your Results

It is unlikely that your dog is suffering from separation anxiety, but if there are other behaviors you see in your dog that are not listed here, please consult your veterinarian to ensure your pet is healthy, happy, and well-adjusted.

While the symptomatic behavior in this questionnaire is often associated with canine separation anxiety, only your veterinarian can make an accurate diagnosis. Please print this questionnaire and take it to your veterinarian so that he or she can help you rule out other possible medical conditions or begin evaluating your dog for separation anxiety.

Does your dog…
Greet you excessively when you return home, even after a short separation?
Constantly try to maintain close contact with you at home, especially when you are preparing to leave?
Bark or whine excessively when left alone?
Try to escape from crates, enclosures or other confinement areas?
Become agitated or distressed when you prepare to leave?
Urinate or defecate in the house only when left alone?
If yes, is the dog completely house-trained?
Display destructive behavior only when left alone?
Exhibit any other unusual behaviors, such as pacing, drooling, vomiting, diarrhea, trembling, withdrawal, self-mutilation, refusal to eat, depression or lethargy?
Exhibit any other behavior you find unacceptable or would like to change?

Questions to Ask Your Veterinarian

  • Based on these behaviors, is it possible that my dog has canine separation anxiety? Are there other potential causes for these behaviors?
  • What other things might I look for to help with diagnosis?
  • My dog is also taking the following medication(s). Might some of the behaviors be related to medication?
  • How do I know if it’s a crate-training issue, rather than a medical condition?
  • How do I know if it’s a house-training issue, rather than a medical condition?
  • Be sure to discuss any additional behaviors causing you concern with your veterinarian. These might also help with accurate diagnosis if your dog is suffering from a medical condition.
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