Feline Inappropriate Elimination Questionnaire

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 *

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. *

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 8:00 am to 5:00 pm
Tuesday 8:00 am to 5:00 pm
Wednesday 8:00 am to 5:00 pm
Thursday 8:00 am to 5:00 pm
Friday 8:00 am to 5:00 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