Please answer the following question and send this back to me via email petrahele gmail com This questionnaire is a part of my research on Charles University in Prague (Czech Republic) where I study psychology. In case you are interested in this research and want know the results, I can send it to you. Most of them will in Czech but I can provide some short overview for English speaking people. thank you Petra Questionnaire: Influence of a guide dog on the psychic of the blind gender: a) male b) female degree of visual impairment a) partial blindness b) totally blindness blind from: a) from birth b) subsequently blind age: a) 15 – 19 years b) 20 – 30 years c) 31 – 45 years d) 46 – 65 e) more than 66 years IN FOLLOWING QUESTIONS YOU CAN CHOOSE MORE ANSWERS 1) What was your main reason for the acquisition of a guide dog? a) guide dog - an assistant in the spatial orientation b) guide dog - a friend, pal c) independence, autonomy d) psychological foothold e) other (please specify) 2) How does the guide dog help you with spatial orientation and independent motion? a) I am not afraid of obstacles unrecognizable with white stick b) I can much better walk through a crowd of people c) walking is faster d) walking is safer e) I enjoy the independent movement f) I feel independent g) other (please specify) 3) What do you consider on living with a guide dog as important? a) the possibility to talk with the dog (to have a faithful listener) b) tactile contact with a dog, soothing touch of warm fur c) sense of security with the presence of a dog (dog as a defender) d) to have always a friend e) the opportunity to confide the dog with own problems f) other (please specify) 4) What is usually the topic of your conversation with a random guide? a) guide dog and everything about dogs b) the topic depends on many things and it varies c) there are often situations, where I do not know what to talk about with the guide. d) other (please specify) 5) Are you able to overcome your fear better with a guide dog? a) yes, I do not feel afraid of the obstacles unrecognizable with white stick b) yes, I am less afraid of falling into rail-yard of underground/train c) yes, I do not have much fear of unknown people (homeless, thieves, etc.) d) yes, I am less worried about losing way e) no, I do not overcome my fear with a guide dog f) other (please specify) IN FOLLOWING QUESTIONS PLEASE CHOOSE ONLY ONE ANSWER 6) Do you think that guide dog has influence on your physical health? a) yes, significantly, how (please write how)? b) yes, partially, how (please write how)? c) no, I do not feel that guide dog would have influence on my health. 7) Does a guide dog stimulate you more to some activities - walks, common daily activities (for example shopping, office)? a) yes, significantly (please write how)? b) yes, partially (please write how)? c) no 8) Do you repeat your well known routes only with white stick? a) yes - please write, how often and why b) no 9) Are you able to pass well known route without a guide dog – only with a white stick? a) yes, no problem. b) yes, but is difficult. c) no, I am not able to walk without guide dog. 10) Do people on the street accost you (speak to you, offer help to you) more often when you have guide dog, than when you only have a white stick? a) yes, I do not need to wait long and somebody will accost (speak to) me. b) people speak to me in the same way often, as when I have only white stick c) no, people speak to me much less 11) Does it irritate you (are you sometimes angry because) that the public care about you more when you have a guide dog than when you have only a white stick? (please give reasons for your answer – for example why) a) yes b) yes, but only in some situations c) no 12) How do you perceive walking with guide dog from the point of memory demands? (please give reasons for your answer – for example, what is difficult for you) a) is significantly less difficult than walking with white stick b) is a little bit less difficult than walking with white stick c) is as difficult as walking with white stick d) is more difficult, than walking with white stick 13) Do you forget route details because of the guide dog? (please give reasons for your answer – for example, why you forget details) a) yes, significantly b) yes, partially c) no, I remember details of all often used routes 14) Does a guide dog have influence on your mood? (please give reasons for your answer – for example, how the dog influences your mood) a) yes, the dog has a positive influence on my mood b) yes, the dog has a negative influence on my mood c) no, the dog does not have any influence on my mood 15) Did the guide dog help you to get sighted friends? (please give reasons for your answer) a) yes, I met many new friends b) yes, I met some new friends c) no, guide dog did not help me to get new friends 16) overcoming anger/rage is for you with guide dog: (please give reasons for your answer) a) simpler b) worse c) no, guide dog does not have influence on it 17) Does the guide dog facilitate you to spend free time better? (please give reasons for your answer) a) yes, significantly b) yes, partially c) no, guide dog does not have influence on it 18) is according to you for healthy people much simpler communicate with blind man with guide dog than with blind with white stick? (please give reasons for your answer) a) certainly yes b) rather no, guide dog does not have influence on communication form the point of the public c) certainly no 19) How difficult is for you walking with white stick only from the point of memory and attention? (please give reasons for your answer) a) very difficult, I feel weary of it b) difficult, but I cannot say to feel weary of it c) easy 20) How much do you have to concentrate on the way walking with guide dog compared to walking with white stick? a) definitely less, I can focus my attention also on something else than on way (for example I think about something) b) less, nevertheless is it however not possible to do something else concurrently c) in the same way in both cases 21) When you have a bad mood, are you sad etc., how does behave your dog? a) tries to gain the contact with me, so overcoming my bad mood is quicker b) tries to gain the contact with me, which irritates me and overcoming my bad mood is slower c) he does not behave exceptionally anyway, which is convenient to me d) he does not behave exceptionally anyway, but it would help me when the dog would try to gain more contact with me 22) Does the guide dog link you much more with healthy public? (please give reasons for your answer) a) yes, the dog links me much more with healthy people b) no, guide dog isn't the one, who me links me with healthy people c) no, the guide dog rather deteriorates link between blind and healthy people 23) Does guide dog help you to better cope with stress situations? (please give reasons for your answer – for example how) a) certainly yes b) sometimes yes, sometimes no c) no, guide dog has no influence on coping with stress situations