Pet Health Survey

(3) Pet Health Survey: Healthy Pets - Healthy Humans - copy
Getting started

This survey is related to the everyday habits of your dog or cat. If you have more than one pet at home, please fill
in the questions for only one pet per survey.
We hope to use the information gathered from this survey to assess changes over time in pet diseases/health issues in residential
settings and identify disease hotspots across the U.S. We believe the public will benefit by having a powerful new way to target, identify
and reduce harmful exposures that are impacting pets, and potentially their humans.
You will have an option at the end of the survey to complete separate surveys for additional pets if you choose. This survey should take
approximately 7 minutes to complete. All responses are voluntary.
Thank you for your time and effort!

1. Are you filling out this survey for your pet cat or dog?
Cat
Dog
I don't have a cat or dog

2. What is your home zip code? *

3. Has your pet spent the majority of its life in the current residence?
I don't know
Yes
No. Please provide zip code and/or state where the pet lived the longest.
*

4. How long has the pet lived in the following (in years):

Current Residence

< 1 year
1 to 5 years
5 to 10 years
> 10 years

Current Zip Code

< 1 year
1 to 5 years
5 to 10 years
> 10 years

Current State

< 1 year
1 to 5 years
5 to 10 years
> 10 years

If you have more than one pet at home, please fill in the questions for only one pet per survey.

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Tell us a little about your pet.

5. What is the sex of your pet?
Female
Male

6. What is the breed of your pet? If mixed, please specify to the best of your ability.

7. How many years of age is your pet?
I don't know
<1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
> 15

8. About how much does your pet weigh (in pounds)?
1 lb
2 lbs
3 lbs
4 lbs
5 lbs
6 lbs
7 lbs
8 lbs
9 lbs
10 lbs
11 lbs

12 lbs
13 lbs
14 lbs
15 lbs
16 lbs
17 lbs
18 lbs
19 lbs
20 lbs
21 lbs
22 lbs
23 lbs
24 lbs
25 lbs
26 lbs
27 lbs
28 lbs
29 lbs
30 lbs
31 lbs
32 lbs
33 lbs
34 lbs
35 lbs
36 lbs
37 lbs
38 lbs
39 lbs
40 lbs
41 lbs
42 lbs
43 lbs
44 lbs
45 lbs
46 lbs
47 lbs

48 lbs
49 lbs
50 lbs
51 lbs
52 lbs
53 lbs
54 lbs
55 lbs
56 lbs
57 lbs
58 lbs
59 lbs
60 lbs
61 lbs
62 lbs
63 lbs
64 lbs
65 lbs
66 lbs
67 lbs
68 lbs
69 lbs
70 lbs
71 lbs
72 lbs
73 lbs
74 lbs
75 lbs
76 lbs
77 lbs
78 lbs
79 lbs
80 lbs
81 lbs
82 lbs
83 lbs

84 lbs
85 lbs
86 lbs
87 lbs
88 lbs
89 lbs
90 lbs
91 lbs
92 lbs
93 lbs
94 lbs
95 lbs
96 lbs
97 lbs
98 lbs
99 lbs
100 + lbs

9. Is your pet considered overweight?
Yes
No
I don't know

10. Is your pet spayed/neutered?
Yes
No
I don't know

11. At what age was your pet spayed/neutered?
< 1 year of age
1 to 3 years of age
3 to 5 years of age
> 5 years of age
I don't know

12. What types of food does your pet eat regularly? Check all that apply.
Dry pet food
Wet pet food
Human grade / table food
Raw diet
Other - please specify

13. What are your pet’s regular sources of water? Check all that apply.
Unfiltered city water
Unfiltered well water
Filtered water
Rainwater
Bottled water
Other - please specify

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Pet health and history

14. Please select any of the following treatments that your pet receives:
Flea / tick treatment (e.g., shampoo, powder, pill, topical)
Flea / tick collar
Routine vaccines (e.g., Rabies, Parvovirus)
Vitamins / supplements
Teeth brushing / other dental care
Heartworm treatment

15. Please check the box(es) below that best describe your pet's history with allergies. Check all that apply.
Has never had

Currently has

Has had in the past I don't know

Food/Gastrointestinal Allergy
Respiratory Allergy
Skin Allergy
Seasonal Allergy

16. Please check the box(es) below that best describe your pet's history with the following health issues. Check
all that apply.
Has never had
Cryptosporidium
Giardia
Heartworms
Influenza
Lead poisoning
Leptospirosis
Pesticide poisoning
Ringworm
Rocky Mountain spotted fever
Other tick-borne diseases (e.g., Lyme, Bartonella)
Skin mites
West Nile virus

Currently has

Has had in the past I don't know

17. Has your pet had any of the following non-cancer health issues during its lifetime? Please check all that
apply and indicate in what stage(s) of life your pet has experienced this issue.
At what life stage(s) has your pet had this issue? Check all that apply.
Never
Arthritis
Benign tumor
Dental or gum disease
Diabetes
Eye issues
Gastrointestinal illness
Heart issues
Kidney issues
Liver illness
Overweight or obese
Pancreatitis
Respiratory illness
Seizures
Thyroid issues (e.g., hyperthyroidism or
hypothyroidism)
Urinary issues

Youth (< 2
years)

Prime (2 - 7
years)

Mature (7 - 10
years)

Senior (> 10
years)

I don't
know

18. Has your pet had any type of cancer during its lifetime? Please check all that apply and indicate in what
stages of life your pet has had each cancer type.
At what life stage(s) has your pet had this cancer? Check all that apply.
Never
Brain (e.g., meningioma)
Blood (e.g., leukemia)
Bone (e.g., osteosarcoma)
Gastrointestinal (e.g., stomach, intestines)
Kidney
Liver
Lung
Lymphatic (e.g., lymphoma)
Mammary (e.g., breast cancer)
Skin (e.g., squamous cell, basil cell, melanoma, or
mast cell tumors)
Urologic (e.g., bladder)
Other

Youth (<2
years)

Prime (2-7
years)

Mature (7-10
years)

Senior (> 10
years)

I don't
know

19. Please provide any additional information about your pet's health history and/or treatments received,
including health issues or traumas not mentioned above.

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Pet behavior

20. Would you say your pet is an indoor or outdoor pet?
Indoor only
Outdoor only
Both indoor and outdoor

Must be percentage

21. For a given week, please estimate the percentage of time your pet spends in the following environments.
Answers must add up to 100%.
Inside the primary home
Directly outside the primary home (e.g., yard)
Around the neighborhood
Local park, trail, or other green space
State park or larger natural area
At pet daycare/sitter
0 out of 100% Total

22. In the following places, is your dog typically on or off leash?
On leash
In your yard
Near your home (e.g., shared lawns, neighboring yards)
Local trails
Urban parks
State parks or larger natural areas
In or around water bodies (e.g., lake, creek)

Off leash

N/A

23. Please tell us how frequently your pet exhibits the following behaviors:
Never Rarely
Digging in yard
Licking its fur/skin
Eating non-food items (e.g., paper, plastic, wood, toys)
Sleeping or sitting on furniture (e.g., couch, beds)
Riding in cars
Mouthing toys (e.g., tennis balls, stuffed animals, ropes)
Hiding
Inappropriate urinating or defecating indoors
Loss of appetite
Destructive behavior (e.g., chewing furniture)
Barking / meowing

24. On average, what is your pet's activity level while awake?
Low
Moderate
High

Sometimes

Often

25. On average, what is your pet's exposure to smoke?
None
Low
Moderate
High

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More info

26. How many cats and dogs live at your home (including both indoor and outdoor pets)?

Cats

0
1
2
3
4
5+

Dogs

0
1
2
3
4
5+

27. How old is your current home?
Less than 1 year
1-5 years
6-10 years
11-15 years
16-20 years
21-30 years
31-40 years
41-50 years
Greater than 50 years
I don't know

28. My neighborhood is best described as:
Urban
Suburban
Rural
Other - Write In

29. The vehicular traffic in my neighborhood is:
Low
Moderate
High

30. Excluding treatment of your pet, are pesticides used indoors or outdoors at the pet's primary residence?
Yes, both
Yes, indoor only
Yes, outdoor only
No
I don't know

Survey Time Action: Hidden Value
Value: Populates with the length of time since the survey taker started the survey
Thank You!

Thank you for taking our survey. Your response provides valuable input information for understanding pet health across the nation. If you
are interested in filling out this survey for another pet, please start a new survey.