Feline Inappropriate Elimination Questionnaire

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Eau Claire Animal Hospital

2504 Mall Drive Eau Claire, WI 54701 715-835-5011

Feline Inappropriate Elimination Questionnaire

* Indicates required field

Name *

First

Last

Contact Phone Number *

Please answer as many questions as you can as it pertains to your cat that is eliminating outside of its litter box. Specific and detailed information is appreciated.

Pet's Name *

Pet's age/birthdate *

Sex *

Number of pets in the househouse:

Cats *

Dogs *

Other species, please list type and number *

Does this cat go outside? *

Yes No

What is the cat's current weight? *

What is the cat's coat length? *

How long has the inappropriate elimination been happening? *

Is your cat declawed? *

Where does the cat urinate in proximity to the litter box? *

If declawed, note front only or all four paws. *

Please describe this cat's general behavior. (reclusive, lethargic, scared, timid, irritable, clingy, etc.) *

Has there been any change in the cat's behavior? Please explain *

If aggressive, is the behavior directed toward any specific person, object, animal? Please explain *

Please list any current and/or past physical and medical problems *

Please list all medications that your cat is currently on. (over the counter, prescriptions, flea & tick preventatives, etc.) *

If your cat is urinating out of the litter box, please answer the following questions.

How often is your cat urinating outside of the box? *

What is your cat's posture as it's urinating? Squat/stand? * *

Is the urine on vertical (wall, door)( or horizontal (floor, bed) surface? *

horizontal vertical unsure

What is the volume of urine? *

Average Large Small

Please describe the location of inappropriate urination (surface, room) *

If your cat is defecating out of the litter box, please answer the following questions.

How often is the cat defecating outside of the box? *

What is the size and consistency of the stool? *

Please describe the location of inappropriate defecation (surface, room). *

Information on litter and litter boxes.

Number of litter boxes *

If you have recently made a change in number of boxes, please list if you added, removed and when. *

Types of boxes and number of each (open, closed, auto). *

Size of boxes *

Litter type *

Always use the same brand Use multiple brands

Please list brand(s) of litter *

Litter consistency *

Scoopable Regular clay Wheat Paper Other

How deep (in inches) do you fill the box? *

Please list any recent changes *

Do you use a box liner? *

Brand of box liner *

Do you use a deodorizer? *

Brand of deodorizer *

How often do you scoop litter? *

How often do you add new litter? *

How often do you completely replace all litter? *

How often do you wash the box? *

Please list in detail the location(s) of boxes, including adjacent appliances and furniture. *

Please check all of following if observed while cat is using the litter box *

stands in box squats in box straddles box meows while in box shakes paw runs away quickly after scratches litter before urination scratches litter after urination scratches litter before defecation scratches litter after defecation scratches other surfaces/objects (side of box, just outside of box, carpet)

Describe behavior when approaching box: relaxed, slow, cautious, etc. *

Describe behavior when leaving the box. *

What type is your home style? (multi-level, ranch, apartment, duplex) *

What is the cat's current diet? (wet, dry, both) please include treats and people food, amount and frequency. *

In what order did this cat enter the household? (first, second, third, etc.) *

How serious is this problem to you? *

Please list any additional information you think the veterinarian should know about your pet. *

Submit

Helpful info

Office hours

Monday 7:15 am to 6:00 pm
Tuesday 7:15 am to 6:00 pm
Wednesday 7:15 am to 6:00 pm
Thursday 7:15 am to 6:00 pm
Friday 7:15 am to 6:00 pm
Saturday 8:00 am to 12:00 pm
Sunday Closed

Boarding release- Sat & Sun from 4-4:30 pm

Get in touch

Address: 2504 Mall Drive, Eau Claire, WI 54701

Phone: 715-835-5011
Fax: 715-835-0993

Email: info@ecanimalhospital.com

Feline Inappropriate Elimination Questionnaire

Helpful info

Office hours

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