Pet Owners Encountering Ticks (PETs) Survey

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PETs Survey
Form Approved, OMB Control No. 0920-1150, Expiration date: 12/31/2019

Welcome to the "Pet Owners Encountering Ticks" (PETs) Study. This survey is conducted through the Maryland
Department of Health and CDC. This survey will take 10 to 30 minutes to complete, depending on how many pets
you have. This survey is voluntary and you may stop the survey or skip questions at any time. When you are finished
with the survey, you will have a chance to provide your contact information to ensure you receive your $10 gift card.
CDC's authority to sponsor this survey is provided by the Public Health Service Act. Your participation is voluntary,
and the information you provide will only be shared with authorized CDC and Emerging Infections Program personnel.

Public reporting burden of this collection of information is estimated to average 10-30 minutes per response,
including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data
needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a
person is not required to respond to a collection of information unless it displays a currently valid OMB Control
Number. Send comments regarding this burden estimate or any other aspect of this collection of information,
including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer, 1600 Clifton Road NE, MS
D-74, Atlanta, Georgia 30333; ATTN: PRA 0920-1150

If you are 18 years of age or older and can answer questions about the care, medication, and activities of your pet(s),
we invite you to take this survey. We are only looking for information about pets that spend time both inside and
outside the home. Your responses will help us better understand how to prevent Lyme disease and other tickborne
diseases.
If you have any questions about the survey, please call 410-767-5649. Please have the access code that was on your
invitation postcard ready so that we can best assist you.
Thank you!
Maryland Department of Health
MDH.pets@maryland.gov
410-767-5649

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What is your age?

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Less than 18 years
18-29 years
30-39 years
40-49 years
50-59 years
60-69 years
70-79 years
80 years or older

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Do you have a dog and/or cat that regularly spends
time both indoors and outdoors?

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Yes
No

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How many DOGS do you have?

I do not have a dog/my dog does not go outside
1
2
3
4
5

How many CATS do you have?

I do not have a cat/my cat does not go outside
1
2
3
4
5

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We're sorry. You are not eligible to take this survey. Thank you for your interest. Please hit the "Next Page" button
below and then click "Submit" on the following page.

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The next few questions will ask about each dog in your household that regularly spends time both indoors and
outdoors. You will tell us about each dog on the following pages.
Dog #1 name:

__________________________________

About how old is [dog1name]?

less than 1 year
1 year
2 years
3 years
4 years
5 years
6 years
7 years
8 years
9 years
10 years
more than 10 years

Please select from the following for [dog1name]:

Male, not neutered
Male, neutered
Female, not spayed
Female, spayed

What size is [dog1name]?

Small (1-25 lbs)
Medium (26-50 lbs)
Large (51-75 lbs)
Giant (>75 lbs)

What length of coat does [dog1name] have?

Short
Medium
Long

About how many hours does [dog1name] spend outside on
an average weekday?

Less than 1
1
2
3
4
More than 4

About how many hours does [dog1name] spend outside on
an average day during the weekend?

Less than 1
1
2
3
4
More than 4

Has [dog1name] been seen by a veterinarian in the
past year?

Yes
No

Has [dog1name] ever been given the Lyme Disease
vaccine?

Yes
No
Unsure/Don't Know

Has [dog1name] ever tested positive for Lyme disease,
Ehrlichiosis, or Anaplasmosis?

Yes
No
Unsure/Don't Know

In the past 6 months, have you found ticks on
[dog1name]?

Yes
No

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About how many ticks have you found crawling on (not
attached to) [dog1name] in the past 6 months?

0
1
2
3
4
5
6
7
8
9
10
More than 10
Don't know/Not sure

About how many ticks have you found attached to (not
just crawling on) [dog1name] in the past 6 months?

0
1
2
3
4
5
6
7
8
9
10
More than 10
Don't know/Not sure

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Dog #2 name:

__________________________________

About how old is [dog2name]?

less than 1 year
1 year
2 years
3 years
4 years
5 years
6 years
7 years
8 years
9 years
10 years
more than 10 years

Please select from the following for [dog2name]?

Male intact
Male neutered
Female intact
Female spayed

What size is [dog2name]?

Small (1-25 lbs)
Medium (26-50 lbs)
Large (51-75 lbs)
Giant (>75 lbs)

What length of coat does [dog2name] have?

Short
Medium
Long

About how many hours does [dog2name] spend outside on
an average weekday?

Less than 1
1
2
3
4
More than 4

About how many hours does [dog2name spend outside on
an average day during the weekend?

Less than 1
1
2
3
4
More than 4

Has [dog2name] been seen by a veterinarian in the
past year?

Yes
No

Has [dog2name] ever been give the Lyme Disease
vaccine?

Yes
No
Unsure/Don't Know

Has [dog2name] ever tested positive for Lyme disease,
Ehrlichiosis, or Anaplasmosis?

Yes
No
Unsure/Don't know

In the past 6 months, have you found ticks on
[dog2name]?

Yes
No

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About how many ticks have you found crawling on (not
attached to) [dog2name] in the past 6 months?

0
1
2
3
4
5
6
7
8
9
10
More than 10
Don't know/Not sure

About how many ticks have you found attached to (not
just crawling on) [dog2name] in the past 6 months?

0
1
2
3
4
5
6
7
8
9
10
More than 10
Don't know/Not sure

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Dog #3 name:

__________________________________

About how old is [dog3name]?

less than 1 year
1 year
2 years
3 years
4 years
5 years
6 years
7 years
8 years
9 years
10 years
more than 10 years

Please select from the following for [dog3name]?

Male intact
Male neutered
Female intact
Female spayed

What size is [dog3name]?

Small (1-25 lbs)
Medium (26-50 lbs)
Large (51-75 lbs)
Giant (>75 lbs)

What length of coat does [dog3name] have?

Short
Medium
Long

About how many hours does [dog3name] spend outside on
an average weekday?

Less than 1
1
2
3
4
More than 4

About how many hours does [dog3name] spend outside on
an average day during the weekend?

Less than 1
1
2
3
4
More than 4

Has [dog3name] been seen by a veterinarian in the
past year?

Yes
No

Has [dog3name] ever been given the Lyme Disease
vaccine?

Yes
No
Unsure/Don't know

Has [dog3name] ever tested positive for Lyme Disease,
Ehrlichiosis, or Anaplasmosis?

Yes
No
Unsure/Don't know

In the past 6 months, have you found ticks on
[dog3name]?

Yes
No

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About how many ticks have you found crawling on(not
attached to) [dog3name] in the past 6 months?

0
1
2
3
4
5
6
7
8
9
10
More than 10
Don't know/Not sure

About how many ticks have you found attached to (not
just crawling on) [dog3name] in the past 6 months?

0
1
2
3
4
5
6
7
8
9
10
More than 10
Don't know/Not sure

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Dog 4 name:

__________________________________

About how old is [dog4name]?

less than 1 year
1 year
2 years
3 years
4 years
5 years
6 years
7 years
8 years
9 years
10 years
more than 10 years

Please select from the following for [dog4name]?

Male intact
Male neutered
Female intact
Female spayed

What size is [dog4name]?

Small (1-25 lbs)
Medium (26-50 lbs)
Large (51-75 lbs)
Giant (>75 lbs)

What length of coat does [dog4name] have?

Short
Medium
Long

About how many hours does [dgo4name] spend outside on
an average weekday?

Less than 1
1
2
3
4
More than 4

About how many hours does [dog4name] spend outside on
an average day during the weekend?

Less than 1
1
2
3
4
More than 4

Has [dog4name] been seen by a veterinarian in the
past year?

Yes
No

Has [dog4name] ever been given the Lyme Disease
vaccine?

Yes
No
Unsure/Don't know

Has [dog4name] ever tested positive for Lyme Disease,
Ehrlichiosis, or Anaplasmosis?

Yes
No
Unsure/Don't know

In the past 6 months, have you found ticks on
[dog4name]?

Yes
No

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About how many ticks have you found crawling on (not
attached to) [dog4name] in the past 6 months?

0
1
2
3
4
5
6
7
8
9
10
More than 10
Don't know/Not sure

About how many ticks have you found attached to (not
just crawling on) [dog4name] in the past 6 months?

0
1
2
3
4
5
6
7
8
9
10
More than 10
Don't know/Not sure

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Dog #5 name:

__________________________________

About how old is [dog5name]?

less than 1 year
1 year
2 years
3 years
4 years
5 years
6 years
7 years
8 years
9 years
10 years
more than 10 years

Please select from the following for [dog5name]:

Male intact
Male neutered
Female intact
Female spayed

What size is [dog5name]?

Small (1-25 lbs)
Medium (26-50 lbs)
Large (51-75 lbs)
Giant (>75 lbs)

What length of coat does [dog5name] have?

Short
Medium
Long

About how many hours does [dog5name] spend outside on
an average weekday?

Less than 1
1
2
3
4
More than 4

About how many hours does [dog5name] spend outside on
an average day during the weekend?

Less than 1
1
2
3
4
More than 4

Has [dog5name] been seen by a veterinarian in the
past year?

Yes
No

Has [dog5name] ever been given the Lyme Disease
vaccine?

Yes
No
Unsure/Don't know

has [dog5name] ever tested positive for Lyme Disease,
Ehrlichiosis, or Anaplasmosis?

Yes
No
Unsure/Don't know

In the past 6 months, have you found ticks on
[dog5name]?

Yes
No

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About how many ticks have you found crawling on (not
attached to) [dog5name] in the past 6 months?

0
1
2
3
4
5
6
7
8
9
10
More than 10
Don't know/Not sure

About how many ticks have you found attached to (not
just crawling on) [dog5name] in the past 6 months?

0
1
2
3
4
5
6
7
8
9
10
More than 10
Don't know/Not sure

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The next few questions will ask about each cat in your household that regularly spends time both indoors and
outdoors. You will tell us about each cat on the following pages.

Cat #1 name:

__________________________________

About how old is [cat1name]?

less than 1 year
1 year
2 years
3 years
4 years
5 years
6 years
7 years
8 years
9 years
10 years
more than 10 years

Please select from the following for [cat1name]:

Male intact
Male neutered
Female intact
Female spayed

What length of coat does [cat1name] have?

Short
Medium
Long

About how many hours does [cat1name] spend outside on
an average weekday?

Less than 1
1
2
3
4
More than 4

About how many hours does [cat1name] spend outside on
an average day during the weekend?

Less than 1
1
2
3
4
More than 4

In the past 6 months, have you found ticks on
[cat1name]?

Yes
No

About how many ticks have you found crawling on (not
attached to) [cat1name] in the past 6 months?

0
1
2
3
4
5
6
7
8
9
10
More than 10
Don't know/Not sure

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About how many ticks have you found attached to (not
just crawling on) [cat1name] in the past 6 months?

0
1
2
3
4
5
6
7
8
9
10
More than 10
Don't know/Not sure

Has [cat1name] been seen by a veterinarian in the
past year?

Yes
No

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Cat #2 name:

__________________________________

About how old is [cat2name]?

less than 1 year
1 year
2 years
3 years
4 years
5 years
6 years
7 years
8 years
9 years
10 years
more than 10 years

Please select from the following for [cat2name]:

Male intact
Male neutered
Female intact
Female spayed

What length of coat does [cat2name] have?

Short
Medium
Long

About how many hours does [cat2name] spend outside on
an average weekday?

Less than 1
1
2
3
4
More than 4

About how many hours does [cat2name] spend outside on
an average day during the weekend?

Less than 1
1
2
3
4
More than 4

In the past 6 months, have you found ticks on
[cat2name]?

Yes
No

About how many ticks have you found crawling on (not
attached to) [cat2name] in the past 6 months?

0
1
2
3
4
5
6
7
8
9
10
More than 10
Don't know/Not sure

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About how many ticks have you found attached to (not
just crawling on) [cat2name] in the past 6 months?

0
1
2
3
4
5
6
7
8
9
10
More than 10
Don't know/Not sure

Has [cat2name] been seen by a veterinarian in the
past year?

Yes
No

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Cat #3 name:

__________________________________

About how old is [cat3name]?

less than 1 year
1 year
2 years
3 years
4 years
5 years
6 years
7 years
8 years
9 years
10 years
more than 10 years

Please select from the following for [cat3name]:

Male intact
Male neutered
Female intact
Female spayed

What length of coat does [cat3name] have?

Short
Medium
Long

About how many hours does [cat3name] spend outside on
an average weekday?

Less than 1
1
2
3
4
More than 4

About how many hours does [cat3name] spend outside on
an average day during the weekend?

Less than 1
1
2
3
4
More than 4

In the past 6 months, have you found ticks on
[cat3name]?

Yes
No

About how many ticks have you found crawling on (not
attached to) [cat3name] in the past 6 months?

0
1
2
3
4
5
6
7
8
9
10
More than 10
Don't know/Not sure

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About how many ticks have you found attached to (not
just crawling on) [cat3name] in the past 6 months?

0
1
2
3
4
5
6
7
8
9
10
More than 10
Don't know/Not sure

Has [cat3name] been seen by a veterinarian in the
past year?

Yes
No

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Cat #4 name:

__________________________________

About how old is [cat4name]?

less than 1 year
1 year
2 years
3 years
4 years
5 years
6 years
7 years
8 years
9 years
10 years
more than 10 years

Please select from the following for [cat4name]:

Male intact
Male neutered
Female intact
Female spayed

What length of coat does [cat4name] have?

Short
Medium
Long

About how many hours does [cat4name] spend outside on
an average weekday?

Less than 1
1
2
3
4
More than 4

About how many hours does [cat4name] spend outside on
an average day during the weekend?

Less than 1
1
2
3
4
More than 4

In the past 6 months, have you found ticks on
[cat4name]?

Yes
No

About how many ticks have you found crawling on (not
attached to) [cat4name] in the past 6 months?

0
1
2
3
4
5
6
7
8
9
10
More than 10
Don't know/Not sure

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About how many ticks have you found attached to (not
just crawling on) [cat4name] in the past 6 months?

0
1
2
3
4
5
6
7
8
9
10
More than 10
Don't know/Not sure

Has [cat4name] been seen by a veterinarian in the
past year?

Yes
No

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Cat #5 name:

__________________________________

About how old is [cat5name]?

less than 1 year
1 year
2 years
3 years
4 years
5 years
6 years
7 years
8 years
9 years
10 years
more than 10 years

Please select from the following for [cat5name]?

Male intact
Male neutered
Female intact
Female spayed

What length of coat does [cat5name] have?

Short
Medium
Long

About how many hours does [cat5name] spend outside on
an average weekday?

Less than 1
1
2
3
4
More than 4

About how many hours does [cat5name] spend outside on
an average day during the weekend?

Less than 1
1
2
3
4
More than 4

In the past 6 months, have you found ticks on
[cat5name]?

Yes
No

About how many ticks have you found crawling on (not
attached to) [cat5name] in the past 6 months?

0
1
2
3
4
5
6
7
8
9
10
More than 10
Don't know/Not sure

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About how many ticks have you found attached to (not
just crawling on) [cat5name] in the past 6 months?

0
1
2
3
4
5
6
7
8
9
10
More than 10
Don't know/Not sure

Has [cat5name] been seen by a veterinarian in the
past year?

Yes
No

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Where do you think your pets are most often exposed
to ticks?

You said "other places". Please specify:

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My yard
Other peoples yards
Neighborhood parks or sports fields
Trails or natural areas
Other places
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The next set of questions will ask about your dogs' activities with human household members.

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In a normal week, how often do any of your DOGS do the following activities with any
household member?
Never

Less than once a 1-2 times a week 3-4 times a week
week

Get hugged or cuddled
Get brushed
Get bathed
Sleep in a household member's
bed
Sleep in a bedroom (not on the
bed)
Get on the furniture (other than
the bed)
Sit on a household member's lap

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More than 4
times a week

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Do you think any of your DOGS get on the bed when no
one is around?

Yes
No

Do you think any of your DOGS go in the bedrooms when
no one is around?

Yes
No

Do you think any of your DOGS get on the furniture
when no one is around?

Yes
No

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Do any household members walk, hike, or run with any
of your DOGS?

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Yes
No

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How often do any of your DOGS walk, hike, or run:
Never

Less than
once a week

Once a week

Several times
a week

Once a day

On the pavement or sidewalk, on
leash
On the pavement or sidewalk,
off leash
On unpaved trails, on leash
On unpaved trails, off leash
In wooded areas, on leash
In wooded areas, off leash
In a field or pasture, on leash
In a field or pasture, off leash
At the beach, on leash
At the beach, off leash
Other
You said "other." Please specify:

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__________________________________

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More than
once a day

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In a typical month, do any of your DOGS go with
household members for outdoor recreation activities
in wooded or brushy areas (e.g., camping, hunting,
or horseback riding)?

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Never
Less than once a month
1-2 times a month
3-4 times a month
More than 4 times a month

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In a normal week, do any of your DOGS play with household members in any of the following
ways?
Never

Less than once
per week

1-2 times per
week

3-4 times per
week

Fetch, inside
Fetch, outside
Rough and tumble or wrestling,
inside
Rough and tumble or wrestling,
outside
Tug of war, inside
Tug of war, outside
Hide and seek or chase, inside
Hide and seek or chase, outside

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More than 4
times per week

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In a normal week, do any of your DOGS do the following?
Never

Go to dogpark or daycare

Less than
1-2 times per
once per week
week

3-4 times per
week

More than 4
times per
week

Kill or catch small animals
Roll in carcasses
Have direct contact with
(touching) animals outside your
home
Spend time roaming unattended
outside your yard
Spend time crated or confined to
a single room

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Unknown

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The next set of questions will ask about your cats' activities with human household members.

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In a normal week, how often do any of your CATS do the following activities with any
household member?
Never

Less than once a 1-2 times a week 3-4 times a week
week

Get hugged or cuddled
Get brushed
Get bathed
Sleep in a household member's
bed
Sleep in a bedroom (not on the
bed)
Get on the furniture (other than
the bed)
Sit on a household member's lap

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More than 4
times a week

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Do you think any of your CATS get on the bed when no
one is around?

Yes
No

Do you think any of your CATS go in the bedrooms when
no one is around?

Yes
No

Do you think any of your CATS get on the furniture
when no one is around?

Yes
No

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Do any household members walk, hike, or run with any
of your CATS?

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Yes
No

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How often do any of your CATS walk, hike, or run:
Never

Less than
once a week

Once a week

Several times
a week

Once a day

On the pavement or sidewalk, on
leash
On the pavement or sidewalk,
off leash
On unpaved trails, on leash
On unpaved trails, off leash
In wooded areas, on leash
In wooded areas, off leash
In a field or pasture, on leash
In a field or pasture, off leash
At the beach, on leash
At the beach, off leash
Other
You said "other." Please specify:

10/05/2017 10:03am

__________________________________

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More than
once a day

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In a normal week, do any of your CATS play with household members in any of the following
ways?
Never

Less than once
per week

1-2 times per
week

3-4 times per
week

Fetch, inside
Fetch, outside
Rough and tumble or wrestling,
inside
Rough and tumble or wrestling,
outside
Tug of war, inside
Tug of war, outside
Hide and seek or chase, inside
Hide and seek or chase, outside

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More than 4
times per week

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In a normal week, do any of your CATS do the following?
Never

Kill or catch small animals

Less than
1-2 times per
once per week
week

3-4 times per
week

More than 4
times per
week

Roll in carcasses
Have direct contact with
(touching) animals outside your
home
Spend time roaming unattended
outside your yard
Spend time crated or confined to
a single room

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Unknown

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The next set of questions will ask about tick control for your pets.

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Which of the following do you do or use to prevent ticks on your pet(s)?
Tick checks

Bathing or
grooming

Tick control Tick control Tick control
on skin
collar
taken by
mouth

Other

Dog(s)
Cat(s)
You said "other" for your DOG(S). Please specify:

__________________________________

You said "other" for your CAT(S). Please specify:

__________________________________

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None

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Do you use the same prevention measures and products
on all of your DOGS?
Why don't you use the same prevention measures on all
of your dog(s)?
Do you use the same prevention measures and products
on all of your CATS?
Why don't you use the same prevention measures on all
of your cat(s)?
Have you used the same tick control products on your
pets for the last 6 months?
You said that you have not been using the same
products for the past 6 months. Please explain:

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Yes
No

__________________________________________
Yes
No

__________________________________________
Yes
No

__________________________________________

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You said you use a tick control product on your pet's skin. Which product did you use most
recently?
K9
Advantix
II (for
dogs only)

Bio Spot

Vectra 3D
(or First
Shield
Trio)

Frontline

Hartz

Revolutio
n

Dog(s)
Cat(s)
You said "other" for your dog(s). Please specify:

__________________________________

You said "other" for your cat(s). Please specify:

__________________________________

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Other

Don't
know

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During which months do you use tick control on your
DOG's skin? (Please check all that apply)

January
February
March
April
May
June
July
August
September
October
November
December

How often do you apply this product to your DOG's
skin?

Less than once a month
Once a month
More than once a month

During which months do you use tick control on your
CAT's skin? (Please check all that apply)

January
February
March
April
May
June
July
August
September
October
November
December

How often do you apply this product to your CAT's
skin?

Less than once a month
Once a month
More than once a month

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You said you use a tick control collar for your pet(s). Which product did you use most
recently?
Preventic Tick
Collar (for dogs
only)

Scalibor (for
dogs only)

Seresto Flea &
Tick Collar

Other

Dog(s)
Cat(s)
You said "other" for your dog(s). Please specify:

__________________________________

You said "other" for your cat(s). Please specify:

__________________________________

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Don't know

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During which months do you use tick control collars
on your DOG(S)? (Please check all that apply)

January
February
March
April
May
June
July
August
September
October
November
December

How often do you replace this collar?

More frequently than every 6 months
Every 6 months
Every 8 months
Every 9-12 months

During which months do you use tick control collars
on your CAT(S)? (Please check all that apply)

January
February
March
April
May
June
July
August
September
October
November
December

How often do you replace this collar?

More frequently than every 6 months
Every 6 months
Every 8 months
Every 9-12 months

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You said you give your pet tick control by mouth. Which product did you use most recently?
Nexguard

Other

Don't know

Dog(s)
Cat(s)
You said "other" for your dog(s). Please specify:

__________________________________

You said "other" for your cat(s). Please specify"

__________________________________

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During which months do you give your DOG(S) tick
control taken by mouth? (Please check all that
apply)

January
February
March
April
May
June
July
August
September
October
November
December

How often do you give this to your DOG?

Less than once a month
Once a month
More than once a month

During which months do you use tick control taken by
mouth for your CAT(S)? (Please check all that apply)

January
February
March
April
May
June
July
August
September
October
November
December

How often do you give this to your CAT?

Less than once a month
Once a month
More than once a month

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The next set of questions will ask about your home.

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In the past 6 months, have you noticed rodents in
your home?

Yes
No

About how often is your home vacuumed or swept?

Daily
1-2 times per week
1-2 times per month
Every other month
1-2 times per year
Never

About how often is your family bedding washed?

Daily
1-2 times per week
1-2 times per month
Every other month
1-2 times per year
Never

About how often is your pet bedding washed?

Daily
1-2 times per week
1-2 times per month
Every other month
1-2 times per year
Never
My pet does not have specific bedding

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The next set of questions will ask about tick encounters among human household members.

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In the past 6 months, has anyone in your household
(including yourself) found ticks crawling or
attached on their body?

Yes
No

How many people in your household (including
yourself) found ticks crawling on or attached to
their body in the past 6 months?

1
2
3
4
5
6
More than 6

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The next set of questions will ask about each household member (including yourself) who found a tick crawling or
attached in the past 6 months. There will be questions for up to 6 household members.

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For the first household member who found ticks
crawling or attached in the past 6 months, what is
his or her age?

0-5 years
6-9 years
10-17 years
18-29 years
30-39 years
40-49 years
50-59 years
60-69 years
70-79 years
80 years or older

For the first household member who found ticks
crawling or attached in the past 6 months, what is
his or her sex?

Female
Male

How many ticks did the first household member find
CRAWLING (not attached) in the past 6 months?

0
1
2
3
4
5
6
7
8
9
10
More than 10
Don't know/Not sure

How many ticks did the first household member find
ATTACHED (not crawling) in the past 6 months?

0
1
2
3
4
5
6
7
8
9
10
More than 10
Don't know/Not sure

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For the second household member who found ticks
crawling or attached in the past 6 months, what is
his or her age?

0-5 years
6-9 years
10-17 years
18-29 years
30-39 years
40-49 years
50-59 years
60-69 years
70-79 years
80 years or older

For the second household member who found ticks
crawling or attached in the past 6 months, what is
his or her sex?

Female
Male

How many ticks did the second household member find
CRAWLING (not attached) in the past 6 months?

0
1
2
3
4
5
6
7
8
9
10
More than 10
Don't know/Not sure

How many ticks did the second household member find
ATTACHED (not crawling) in the past 6 months?

0
1
2
3
4
5
6
7
8
9
10
More than 10
Don't know/Not sure

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For the third household member who found ticks
crawling or attached in the past 6 months, what is
his or her age?

0-5 years
6-9 years
10-17 years
18-29 years
30-39 years
40-49 years
50-59 years
60-69 years
70-79 years
80 years or older

For the third household member who found ticks
crawling or attached in the past 6 months, what is
his or her sex?

Female
Male

How many ticks did the third household member find
CRAWLING (not attached) in the past 6 months?

0
1
2
3
4
5
6
7
8
9
10
More than 10
Don't know/Not sure

How many ticks did the third household member find
ATTACHED (not crawling) in the past 6 months?

0
1
2
3
4
5
6
7
8
9
10
More than 10
Don't know/Not sure

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For the fourth household member who found ticks
crawling or attached in the past 6 months, what is
his or her age?

0-5 years
6-9 years
10-17 years
18-29 years
30-39 years
40-49 years
50-59 years
60-69 years
70-79 years
80 years or older

For the fourth household member who found ticks
crawling or attached in the past 6 months, what is
his or her sex?

Female
Male

How many ticks did the fourth household member find
CRAWLING (not attached) in the past 6 months?

0
1
2
3
4
5
6
7
8
9
10
More than 10
Don't know/Not sure

How many ticks did the fourth household member find
ATTACHED (not crawling) in the past 6 months?

0
1
2
3
4
5
6
7
8
9
10
More than 10
Don't know/Not sure

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For the fifth household member who found ticks
crawling or attached in the past 6 months, what is
his or her age?

0-5 years
6-9 years
10-17 years
18-29 years
30-39 years
40-49 years
50-59 years
60-69 years
70-79 years
80 years or older

For the fifth household member who found ticks
crawling or attached in the past 6 months, what is
his or her sex?

Female
Male

How many ticks did the fifth household member find
CRAWLING (not attached) in the past 6 months?

0
1
2
3
4
5
6
7
8
9
10
More than 10
Don't know/Not sure

How many ticks did the fifth household member find
ATTACHED (not crawling) in the past 6 months?

0
1
2
3
4
5
6
7
8
9
10
More than 10
Don't know/Not sure

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For the sixth household member who found ticks
crawling or attached in the past 6 months, what is
his or her age?

0-5 years
6-9 years
10-17 years
18-29 years
30-39 years
40-49 years
50-59 years
60-69 years
70-79 years
80 years or older

For the sixth household member who found ticks
crawling or attached in the past 6 months, what is
his or her sex?

Female
Male

How many ticks did the sixth household member find
CRAWLING (not attached) in the past 6 months?

0
1
2
3
4
5
6
7
8
9
10
More than 10
Don't know/Not sure

How many ticks did the sixth household member find
ATTACHED (not crawling) in the past 6 months?

0
1
2
3
4
5
6
7
8
9
10
More than 10
Don't know/Not sure

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Where do you think your household members are most
often exposed to ticks?

You said "other places". Please specify:

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My yard
Other people's yards
Neighborhood parks or sports fields
Trails or natural areas
Other places
__________________________________

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The next set of questions will ask about tick bite prevention for human household members.

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In the past 6 months, what steps have you taken to
stop ticks from biting you or other household
members? (Please check all that apply)

You chose "other". Please specify:

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Tick checks
Bathing or showering after being outside
Repellent applied to skin
Repellent applied to clothes
Yard-based tick control
Other
None
__________________________________

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What type of yard-based tick control do you use?
(Please check all that apply)

You chose "other". Please specify:

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Chemicals sprayed in yard to kill ticks
Natural products sprayed in yard to kill ticks
Boxes that apply chemicals to rodents to kill ticks
Special landscaping to limit ticks
Fencing to keep deer out of yard
Other
None
__________________________________

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What size is your yard?

I don't have a yard
Less than 0.5 acres
0.5 to 1 acre
1 to 3 acres
3 to 5 acres
Greater than 5 acres

Which of the following features do you have in your
yard? (Please check all that apply)

Manicured lawn
Wooded/brushy areas
Pasture land
Garden
Compost pile
Log pile
Bird feeder
Stone walls
Children's play equipment

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Do you avoid any of the following activities
specifically to prevent ticks from getting on you or
other household members? (Please check all that
apply)

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Hugging or cuddling your pet
Brushing your pet
Bathing your pet
Sleeping with your pet
Letting your pet in the bedroom
Letting your pet on furniture
Letting pet sit in lap
Playing fetch with pet
Wrestling with pet
Playing tug of war with pet
Playing hide and seek or chase with pet
None of the above

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Do you avoid any of the following activities
specifically to prevent ticks from getting on your
pets? (Please check all that apply)

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Walking, running, or hiking with pet
Sending pet to daycare or dog park
Letting pet contact other animals
Letting pet roam unattended
None of the above

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The next set of questions will ask for demographic information about you and your household.

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What is the highest grade or year of school you
completed?

Never attended school or kindergarten
Elementary or middle school; 1st- 8th grade
Some high school; 9th- 11th grade
High school graduate; 12th grade or GED
College or technical school for 1-3 years
College for 4 years, with or without a degree
Graduate school
Don't know/Not sure

What is your sex?

Female
Male

What is your ethnicity?

Hispanic or Latino
Not Hispanic or Latino

What is your race? (Please check all that apply)

American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White

How many people are living in your household?

1
2
3
4
5
6
7
8
9
10
11
12
More than 12

What is your annual household income?

less than $50,000
$50,000-100,000
$100,000-200,000
greater than $200,000
Don't know/Not sure

What is your zip code?

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How did you hear about this survey? (Please check all
that apply)

You said "Other". Please specify:

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Veterinarian clinic
Postcard invitation in the mail
Rabies clinic
Pet store
Facebook
Other
__________________________________

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Thank you for taking this survey! We value your participation. As a token of appreciation, we would like to offer you a
$10 gift card to Target.
If you would like to receive this gift card in the mail, please email the Maryland Department of Health study
coordinator at MDH.pets@maryland.gov with the following information:
YOUR NAME
MAILING ADDRESS
SURVEY ACCESS CODE (located on your survey invitation postcard)
If you prefer, you may also call the study coordinator at 410-767-5649 with the above information.
The information you provide will only be shared with authorized Maryland Department of Health personnel for the
purposes of mailing your gift card.
Please keep the survey access code from your postcard until you receive your gift card!

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If you would like to participate in future studies about pets conducted by the Maryland Department of Health and
CDC, please email study coordinators at:
MDH.pets@maryland.gov

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