Just Cats Veterinary Services

1015 Evergreen Circle
The Woodlands, TX 77380

(281)367-2287

justcatsvets.com

Inappropriate Elimination Form

Name (required)
First Name (required)
Last Name (required)
Cat's Name: (required)

Inappropriate Elimination
Please take a few minutes to complete the following questionnaire. Detailed information will help us find the quickest and best solution for your cat's inappropriate elimination issues.
How many cats do you have in your home? How many and what type of other pets do you have? (required)

How many litter boxes do you have in your house? (required)

What type of litter boxes do you have in your home?(ie-covered/uncovered/automatic scooping, etc...) (required)

Where are all the litter boxes located? (required)

Have you recently changed the location of your litter boxes? (required)
Yes
No


Have you recently replaced any of the litter boxes? (required)
Yes
No


How big are your litter boxes? (required)

How deep are your litter boxes? (required)

How often do you scoop or change the litter boxes? (required)

How often do you wash or change the litter box completely? (required)

What do you clean the boxes with? (ie- Soap, bleach..) (required)

What type of litter are you using? (ie scoopable. clay. pine, paper, etc...) (required)

The litter you use is: (required)
Scented
Unscented


Have you recently changed litter type or brand? (required)
Yes
No


Are you using additives in your litter such as baking soda or Cat Attract? (required)
Yes
No


If so, what additives are you using?

Do you use litter box liners? (required)
Yes
No


Have you recently changed location of your litter boxes? (required)
Yes
No


How long has your cat been inappropriately eliminating? (required)

Does your cat urinate, defecate or both outside of litterbox? (required)
Urinate
Defecate
Both


Where in the house is the inappropriate elimination happening? (required)

How often does it occur? (required)

Does your cat still use the litter box at all? (required)
Yes
No


If so, for what?
Urination
Defecation
Both


Does your cat: (required)
Stand and spray urine
Squat and urinate


Does your cat have a history of arthritis or an injury that prevents a normal position in the litter (required)
Yes
No


If so, please explain:

Does your cat have a history of urinary problems, such as urinary crystals/stones or kidney disease? (required)

Does your cat have a history of defecation problems, such as constipation or chronic diarrhea? (required)

Has there been any changes in home such as new baby/pet, construction, moving, etc...? (required)
Yes
No


If so, explain:

Any aggressive pets in home that would chase ot intimidate your cat keeping him from the litter box? (required)
Yes
No


Is your cats water consumption normal? (required)
Yes
No


Have you noticed an increase in urine or stool in the litter box? If so, exlplain: (required)

Has your cat been having diarrhea? (required)
Yes
No


If so, how long?

Is your cat straining to urinate or crying out while urinating? (required)
Yes
No


If so, explain:

Is your cat straining to defecate or crying out while defecating? (required)
Yes
No


If so, explain:

What best describes your cats lifestyle? (required)
Indoor Only
Outdoor Only
Indoor/Outdoor


If your cat goes outside, is he/she supervised while outside?
Yes
No


Has your cats lifestyle changed since the inappropriate elimination started? (required)
Yes
No


Have you noticed any new wildlife or construction near your home? Please Explain. (required)

Is your cat currently on any medication? (required)
Yes
No


If so, please list all medications, concentrations, amount given and how often.

Do you use any items that your cat would have to travel over or through to get to litter box? (required)

Do you have any other concerns about your cats behavior that is not listed above? (required)

Additional information needed for appointment:
Please bring a schematic of your home in with you for your appointment. Have listed where the windows, doors, litter boxes, pet beds, feeding stations are located and locations of where the inappropriate elimination is occurring. Please email photos of your litter boxes to vets@justcatsvets.com prior to your appointment. We will see you soon!

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