What is your dog's name? * What is the size of your dog * Select option Small dog Medium dog Large dog What breed is your dog? * Select option Small dog Medium dog Large dog How old is your dog? * Select option Young dog Middle-aged dog Old dog What caused your dog to become blind? * Select option Cataract Progressive Retinal Atrophy (PRA) Glaucoma Retinal Degeneration Keratoconjunctivitis Sicca (KCS) Retinal Detachment Diabetes Uveitis Collie Eye Anomaly (CEA) Lens Luxation Optic Nerve Hypoplasia Ocular Tumors Leishmaniasis Chronic Ocular Infections Ocular Trauma Lyme Disease other Lyme Disease Since when your has dog been blind? * Select option Recently 0 to 1 year Since 1 to 3 years Since 3 years and more Does your dog has normal hearing? * Select option Normal hearing Moderate hearing loss Severe hearing loss or deafness Is your dog expreincing any mental health issues? * Select option Normal mental capacities Moderate cognitive decline Severe cognitive decline Submitt