Canine Cognitive Assessment

Today's Date:*

Owner's Name:*

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Pet's Name:*

Primary Phone #:*

Primary Email:*

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A: Spatial Awareness

My dog appears lost or confused in a familiar environment (inside/outside)*

0 - I have never observed this behavior in my pet
1 - I have observed this behavior at least once in the last 6 months
2 - I have observed this behavior at least once per month
3 - I have observed this behavior at least 2-4 times per month
4 - I have observed this behavior several times per week

My dog struggles to recognize familiar people and animals inside or outside my home*

0 - I have never observed this behavior in my pet
1 - I have observed this behavior at least once in the last 6 months
2 - I have observed this behavior at least once per month
3 - I have observed this behavior at least 2-4 times per month
4 - I have observed this behavior several times per week

My dog responds abnormally to familiar objects around my home*

0 - I have never observed this behavior in my pet
1 - I have observed this behavior at least once in the last 6 months
2 - I have observed this behavior at least once per month
3 - I have observed this behavior at least 2-4 times per month
4 - I have observed this behavior several times per week

My dog wanders around without purpose or direction*

0 - I have never observed this behavior in my pet
1 - I have observed this behavior at least once in the last 6 months
2 - I have observed this behavior at least once per month
3 - I have observed this behavior at least 2-4 times per month
4 - I have observed this behavior several times per week

My dog has difficulty performing previously learned tasks*

0 - I have never observed this behavior in my pet
1 - I have observed this behavior at least once in the last 6 months
2 - I have observed this behavior at least once per month
3 - I have observed this behavior at least 2-4 times per month
4 - I have observed this behavior several times per week

B: Sleep-Wake Cycles

My dog has abnormal nighttime behaviors (wandering, vocalization, restlessness)*

0 - I have never observed this behavior in my pet
1 - I have observed this behavior at least once in the last 6 months
2 - I have observed this behavior at least once per month
3 - I have observed this behavior at least 2-4 times per month
4 - I have observed this behavior several times per week

My dog sleeps most of the day*

0 - I have never observed this behavior in my pet
1 - I have observed this behavior at least once in the last 6 months
2 - I have observed this behavior at least once per month
3 - I have observed this behavior at least 2-4 times per month
4 - I have observed this behavior several times per week

C: Social Interactions

My dog is less interested in interacting with other people or animals (welcoming, petting, playing, etc.)*

0 - I have never observed this behavior in my pet
1 - I have observed this behavior at least once in the last 6 months
2 - I have observed this behavior at least once per month
3 - I have observed this behavior at least 2-4 times per month
4 - I have observed this behavior several times per week

My dog no longer enjoys activities that used to excite them (playing with toys, walks/ exercise, etc.)*

0 - I have never observed this behavior in my pet
1 - I have observed this behavior at least once in the last 6 months
2 - I have observed this behavior at least once per month
3 - I have observed this behavior at least 2-4 times per month
4 - I have observed this behavior several times per week

My dog is less responsive to commands*

0 - I have never observed this behavior in my pet
1 - I have observed this behavior at least once in the last 6 months
2 - I have observed this behavior at least once per month
3 - I have observed this behavior at least 2-4 times per month
4 - I have observed this behavior several times per week

My dog appears anxious with changes in routine or in new environments*

0 - I have never observed this behavior in my pet
1 - I have observed this behavior at least once in the last 6 months
2 - I have observed this behavior at least once per month
3 - I have observed this behavior at least 2-4 times per month
4 - I have observed this behavior several times per week

My dog has acted fearful or aggressive toward people, animals, or environmental stimuli*

0 - I have never observed this behavior in my pet
1 - I have observed this behavior at least once in the last 6 months
2 - I have observed this behavior at least once per month
3 - I have observed this behavior at least 2-4 times per month
4 - I have observed this behavior several times per week

D: House Soiling

My dog eliminates in random locations around the house*

0 - I have never observed this behavior in my pet
1 - I have observed this behavior at least once in the last 6 months
2 - I have observed this behavior at least once per month
3 - I have observed this behavior at least 2-4 times per month
4 - I have observed this behavior several times per week

My dog eliminates in their kennel or sleeping area*

0 - I have never observed this behavior in my pet
1 - I have observed this behavior at least once in the last 6 months
2 - I have observed this behavior at least once per month
3 - I have observed this behavior at least 2-4 times per month
4 - I have observed this behavior several times per week

My dog has shown a change in how/when they ask to go outside*

0 - I have never observed this behavior in my pet
1 - I have observed this behavior at least once in the last 6 months
2 - I have observed this behavior at least once per month
3 - I have observed this behavior at least 2-4 times per month
4 - I have observed this behavior several times per week

My dog sometimes eliminates indoors and/or outdoors after a current walk or trip outside*

0 - I have never observed this behavior in my pet
1 - I have observed this behavior at least once in the last 6 months
2 - I have observed this behavior at least once per month
3 - I have observed this behavior at least 2-4 times per month
4 - I have observed this behavior several times per week

My dog eliminates in unusual outdoor locations (rocks, concrete, etc.)*

0 - I have never observed this behavior in my pet
1 - I have observed this behavior at least once in the last 6 months
2 - I have observed this behavior at least once per month
3 - I have observed this behavior at least 2-4 times per month
4 - I have observed this behavior several times per week

Behavior: Final Score*

Equation to get final score: A + (Bx2) + C + D

A: Spatial Awareness

B: Sleep-Wake Cycles

C: Social Interactions

D: House Soiling

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