🌿 IHAIC Research Participation Form

  • 🌿 IHAIC Research Participation Form

    Thank you for your willingness to contribute to ongoing graduate-level research within IHAIC.This study explores mirrored somatic and emotional patterns between humans and animals within the same household. Your participation supports both structured analysis and deeper case understanding. Participation is voluntary.

  • Anonymity Preference

  • How would you like to be identified in research reporting?*
  • Format: (000) 000-0000.
  • Do we have permission to contact you if we have further questions?

  • Household Overview

  • Human Health History

  • Have you experienced any of the following? (Check all that apply)*
  • If applicable, when did your symptoms begin?*
  • On a scale of 1-5, how severe are your current symptoms?*

  • Animal Health History (Primary Paired Animal)

    Please respond with your closest pet's history.
  • Has your closest bonded pet experienced any of the following? (Check all that apply)*
  • If applicable, when did your symptoms begin?*
  • On a scale of 1-5, how severe are your current symptoms?*

  • Mirroring & Behavioral Synchrony

  • To what degree do you feel your animal mirrors your emotional or physical state?*
  • When you experience stress or illness, how does your animal respond?*

  • Temperament & Traits

  • How would you describe your temperament? (Check all that apply)*
  • How would you describe your animal's temperament? (Check all that apply)*
  • How would you describe your household most of the time?*
  • Your activity level most of the time:*
  • Is your animal exercised regularly?*

  • Integrative Modalities Used

  • Have you used holistic modalities for yourself or your animal?*

  • Optional Photo Submission

    You may upload a photo of yourself with your animal.
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  • I consent that this photo can be utilized for:*

  • Follow-up Participation

  • Would you be open to:*
  • Preferred contact method:*

  • Final Consent

    This research is conducted through the Institute for Human Animal Integrative Care (IHAIC) in affiliation with the University of Metaphysics and the University of Sedona. Your responses will be used for graduate-level academic research, university publication, and may be included in future published works including books, articles, and educational materials. Participation is entirely voluntary. You may withdraw at any time prior to submission. By submitting this form, you confirm that you are 18 years of age or older and consent to the use of your responses as described above.
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