| Question | Options |
| 1. Has your cat or dog worn an Elizabethan Collar in the past twelve months? |
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| 2. Your age (years) _____ | *insert age in years* |
| 3. Your gender |
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| 4. Postcode | *insert postcode* |
| 5. Are you a veterinarian, veterinary nurse, veterinary technician, animal trainer or a person who works with animals for a living? |
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| 6. In your household, responsibility for the care of your companion animal is: |
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| 7. How long was your companion animal required to wear an Elizabethan collar? |
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| 8. What was the reason? |
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| 9. Which activities, if any, did the collar interfere with (rate all that apply) [1 = cannot perform this activity when wearing collar; 2 = has some difficulty performing this activity when wearing collar; 3 = needs assistance when performing this activity; 4 = Elizabethan collar makes minimal difference when performing this activity; 5 = Elizabethan collar makes no difference to performance of this activity] |
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| 10. Are you aware of how to check whether your companion animal Elizabethan collar is too tight/loose or not? |
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| 11. Did your companion animal exhibit any difficulty breathing while wearing the Elizabethan collar? |
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| 10a. If yes, did these difficulties breathing exist before the use of the Elizabethan collar due to prior health problems? |
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| 12. Were you required to re-size or replace your pet’s Elizabethan collar in the duration that they were required to use it? |
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| 11a. If yes, why? |
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| 13. Did your companion animal acquire any injuries as a result of the Elizabethan collar? (tick all that apply) |
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| 14. While wearing the collar, you would say that your pet’s response to sound is: |
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| 15. Did you remove the Elizabethan collar during the time its use was prescribed: |
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| 16. How often did your companion animal remove the collar without your assistance |
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| 17. If you had any other companion animals at the time your companion animal was required to use an Elizabethan collar, did interactions between these animals change? |
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| 18.Have you ever used alternatives to achieve the same purpose as an Elizabethan collar? (tick all that apply) |
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| 17a. If so, was it: |
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| 19. Rate your companion animal’s quality of life WITH the Elizabethan collar from 1–5 [1 (Couldn’t be better)–5 (very poor)] |
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| 20. Rate your companion animal’s quality of life WITHOUT the Elizabethan collar from 1–5 [1 (Couldn’t be better)–5 (very poor)] |
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| 21. Do you wish to provide any additional comments? | *insert any addition comments* |