Questionnaire based on the Canine Cognitive Dysfunction Rating (CCDR) Scale. Please answer all items based on your dog’s behavior.

This field is for validation purposes and should be left unchanged.

Owner and pet information

Please enter a number greater than or equal to 0.

Current behaviors

Choose one response for every question.
1. How often does your dog pace up and down, walk in circles and/or wander with no direction or purpose?(Required)
2. How often does your dog stare blankly at the walls or floor?(Required)
3. How often does your dog get stuck behind objects and is unable to get around?(Required)
4. How often does your dog fail to recognise familiar people or pets?(Required)
5. How often does your dog walk into walls or doors?(Required)
6. How often does your dog walk away while, or avoid, being patted?(Required)
7. How often does your dog have difficulty finding food dropped on the floor?(Required)

Changes compared with 6 months ago

8. Compared with 6 months ago, does your dog now pace up and down, walk in circles and/or wander with no direction or purpose?(Required)
9. Compared with 6 months ago, does your dog now stare blankly at the walls or floor?(Required)
10. Compared with 6 months ago, does your dog urinate or defecate in an area it has previously kept clean?(Required)
If your dog has never house-soiled, select 'The same'.
11. Compared with 6 months ago, does your dog have difficulty finding food dropped on the floor?(Required)
12. Compared with 6 months ago, does your dog fail to recognise familiar people or pets?(Required)
13. Compared with 6 months ago, is the amount of time your dog spends active?(Required)

CCDR score

The total is calculated automatically based on the published questionnaire, including the x2 and x3 weights.
Published interpretation: 0–39 = Normal; 40–49 = At risk; 50+ = CCD. The score is a screening aid, not a standalone diagnosis.

Scale reproduced from the supplied University of Sydney Regenerative Neuroscience Group questionnaire. Responses will be sent only to the website configured to receive this form; contact/return instructions printed on the paper original are not used for online delivery.