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General Questions
Cat's Name
*
Age
*
Gender
*
Male
Female
Approximate Weight
*
How long have you had your cat?
*
Have you taken your cat to the vet specifically for this issue?
*
Yes
No
Does the vet suspect an illness or other medical problem?
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Yes
No
Is your cat spayed/neutered?
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Yes
No
Please describe your cat's personality in a sentence or two.
*
How long has the inappropriate elimination been occurring? (Years/months/weeks)
*
Do you remember the first incident? If so, please describe.
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Does your cat only urinate, only defecate, or do both outside of the box? If mostly urination with occasional defecation, or vice versa, please include this info.
*
How often does your cat eliminate outside the box?
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Every time they go
Once a day or so
A couple times a week
Once a month or so
Less than once a month
What kind of surface is targeted? Please mark all that apply.
*
Carpet
Wood
Vinyl
Tile
Bedding/clothing
Bath/shower/sink
A person
Other
If you checked "other," please describe.
Does your cat eliminate in the same locations repeatedly, or in various locations?
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Same locations repeatedly
Various locations
Does your cat urinate on vertical surfaces (walls, doors, sides of furniture, etc.)?
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Yes
No
How are you cleaning the locations or objects after your cat has eliminated on them?
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If you have ever caught your cat in the act of inappropriate elimination, how do you respond?
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Have there been any recent changes to the environment or your cat’s routine? E.g., buying a new piece of furniture or rearranging a room; switching the type of food offered; new roommate; recent vacation; new work schedule.
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Litter Box Questions
How many litter boxes do you have? If you have a multi-story home, do you have a box on each floor?
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What kind of litter box do you use?
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Covered
Uncovered
Other
If you chose "other," please describe:
What size litter box do you use? Please include length, width, and depth.
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Where is your litter box located? Please describe the area around it- next to a washer and dryer, in the corner of a closet, next to a couch in the livingroom, etc.
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Do you use a liner?
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Yes
No
What type of litter do you use?
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Clumping
Non-clumping
Clay
Shavings
Pellets
Other
What brand is the litter?
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Is the litter you use labeled as 'unscented' litter?
Yes
No
Unsure
How much litter do you keep in the box?
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Just enough to cover the bottom
One to three inches
Four inches or more
How frequently do you scoop your litter boxes?
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How frequently do you dump all litter, clean boxes, and replace with fresh litter? Do you use a cleaning product when you do this (soap, disinfectant, etc.) or do you just use water?
*
Environmental Questions
Does your cat go outside? Please mark all that apply.
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Yes
No
Only supervised
Unsupervised
Has catio or outdoor enclosure
During the day
During the night
Can your cat see any non-household animals from inside your home?
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Yes
No
Unsure
If yes, please describe (birds at feeder, neighbor’s cat, raccoons looking for food at night, etc.)
What is the general activity level of your home?
*
Peaceful and quiet
Active and noisy
Mostly quiet but with times of high noise and activity
Is there activity that goes on outside your home? Construction, elementary school on the street, busy/loud road, etc.
*
How often do you play with your cat? What do you use to play with them?
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Does your cat play with their toys on their own? If so, how often?
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Do you have vertical space for your cat (cat trees, shelves, window hammocks, etc.)?
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Do you have scratchers in your home? If so, how many, what kinds (vertical, horizontal, cardboard, sisal rope, etc.) and does your cat use them?
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Please describe other enrichment you provide for your cat, e.g. water fountains, cat beds, boxes, catnip, ‘cat TV’, cat grass, etc.
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Other Household Animal Questions
Do you have any other pets?
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Yes
No
Do you have any other cats?
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Yes
No
How many other cats do you have?
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How long have you had each cat?
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Are you confident you know which cat is engaging in inappropriate elimination? If yes, how do you know?
*
In general, how do your cats get along? Please be as descriptive as possible. Do they play, do they fight, are you unsure if behavior is playing or fighting, do they cuddle or groom each other, ignore each other, etc.?
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Please describe how you manage food. Do you always have food out for your cats, do you have set mealtimes and they are given bowls next to each other, are they put in separate rooms for mealtimes, etc.? Do they ever try to eat each other’s food?
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Do you have any dogs?
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Yes
No
If yes, how many and what kind? Please specify large or small.
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How long have you had each dog?
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In general, how does your cat get along with the dog(s)? Please be as descriptive as possible. Does the dog ever chase the cat, does the cat ever hiss at the dog, do they play, do they cuddle, ignore each other, etc?
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Please describe how you manage food. Do you always have food out for both or either of your animals? Do they have set mealtimes and are fed in the same room, or in separate rooms? Do they ever try to eat each other’s food?
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Do you have other animals? (e.g. birds, fish, rodents, horses)
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Yes
No
How long have you had them?
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Does your cat interact or show any interest in these animals? Please describe any interactions.
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People Questions
How many people in your household, and what ages for any children?
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How does your cat interact with all the adults in the household? Do they have ‘favorite’ people? Is there anyone they avoid or are afraid of? Do they ever bite or scratch anyone, and if so, is it during playful interactions or other interactions?
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How does your cat interact with the children in the household, if any?
How does your cat react to visitors/strangers? Do they hide, do they greet them right away, are they wary but eventually friendly?
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