If your pet is soiling the house, please make an appointment for an exam and a consultation.
Fill out this form and bring it with you to your visit.
DESCRIBE THE TYPE OF HOUSESOILING PROBLEM.
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WHEN DID THE PROBLEM START?
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DOES IT CORRELATE TO ANY CHANGES IN THE CAT’S ENVIRONMENT OR ROUTINE?
XXXX____Yes XXXXX____No
HOW MANY CATS ARE IN THE HOUSEHOLD?_________________
ARE THERE OTHER PETS?XXXX____Yes XXXXX____No
IS THE CAT ALLOWED OUTDOORS?XXXX____Yes XXXXX____No
WHAT BRAND AND TYPE OF LITTER IS USED?
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CHANGED TYPE OR BRAND RECENTLY?
____Yes XXXXXXXXX_____No
IS ANYTHING ADDED TO THE LITTER?XXXX____Yes XXXXX____No
WHAT IS THE SIZE AND HEIGHT OF THE LITTER BOX?
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IS IT A COVERED BOX?XXXX____Yes XXXXX____No
IS A LINER USED?XXXX____Yes XXXXX____No
HOW OFTEN IS FECAL MATERIAL REMOVED?
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HOW OFTEN IS THE LITTER COMPLETELY CHANGED?
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WHERE IS THE BOX LOCATED?
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WHERE AND WHEN DOES THE CAT SOIL? (USE BACK OF PAGE TO DRAW MAP OF HOUSEHOLD)
DESCRIBE IN DETAIL WHERE THE SOILING OCCURS - WALLS, FLOORS, ETC.
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DOES THE CAT COVER ITS FECES?XXXX____Yes XXXXX____No
DOES THE CAT SCRATCH OUTSIDE THE PAN OR IN THE AIR?XXXX____Yes XXXXX____No
DOES THE CAT PERCH ON THE EDGE OF THE PAN TO URINATE?XXXX____Yes XXXXX____No
TO DEFECATE?XXXX____Yes XXXXX____No
WHAT IS THE CAT’S MEDICAL HISTORY?
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WHAT ARE THE RESULTS OF ANY DIAGNOSTIC TEST THAT MIGHT BE PERTINENT TO THIS PROBLEM?
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