Inappropriate Elimination Questionnaire House soiling can occur for many reasons which makes it a very difficult problem for a cat owner to solve. The following questionnaire will be used to try to pinpoint some possible reasons for your cat’s behavior. Please take the time to answer these questions as completely as you can. Although it’s a lot of work, it will be less work than dealing with the problem of cleaning up after your cat time after time.Owner's Name* First Last Email* Cat's Name*Age*Sex*MaleFemaleIs your cat's house soiling problem urine, stool or both?*UrineStoolBothWhat percentage of the problem is urine?*Please enter a number less than or equal to 100.What percentage of the problem is stool?*Please enter a number less than or equal to 100.How long has house soiling been a problem?*Frequency of soiling when the problem started (ex. Once daily, once weekly, etc):*Frequency of soiling at present time:*Important Medical History Please check all signs that are presentDoes your cat display any of these urination patterns? (Check all that apply) Strains when urinating Crouches to urinate a long time in the litter box Cries when urination Blood in the urine Licks the genital area excessivelyApproximate number of urinations per day:*Regarding the stools, which of these describes your cat's bowel movements? (Check all that apply) Formed and log-shaped Soft but almost formed Mucous in the stool Strains when defecating Liquid Intermittently formed and soft/liquid Stools are hard and dry Cries when defecating Pudding-like Blood in the stool Stools contain excess hair Stool clings to the rear end after defecatingApproximate number of bowel movements per day:*House Soiling HistoryIf urine soiling is present, is it on:Horizontal surfaces (ex. floors)Vertical surfaces (ex. walls)Both horizontal and vertical surfacesIf urine soiling is present, is the soiling characterized by:Large puddlesSmall puddlesHave you witnessed incidents of soiling?YesNoIf you have witnessed soiling (urine & stool) incidents, which of these actions describes the behavior? (Check all that apply): Sniffs target area, backs up to a vertical surface, hind-foot treading, tail upright and quivering, emits a stream of urine Makes several abrupt treading movements with hind feet, slowly squats on a horizontal surface, tail quivering, urinates or defecates Squats, then urinates or defecates with little or no tail quivering Sniffs soiled area after urinating or defecating Digs and paws around soiled area after urinating or defecating Walks away or runs off without pawing around or sniffing soiled areaWith the above actions in mind, describe the sequence of actions of kitty's typical soiling behavior:Does kitty soil in the bathtub, shower or sink?*YesNoPlease describeDoes the soiling occur near a litter box?*YesNoIs it urine and/or stool?*UrineStoolUrine and stoolHow frequently does it occur?*How far from the litter box?*Does soiling occur near an outside door or window?*YesNoIs it urine and/or stool?*UrineStoolUrine and stoolHow frequently does it occur?*Are other animals sometimes present outside the door or window?*YesNoDescribe the circumstances:*Describe all the locations of soiling in the house, types of surfaces (ex. carpet, hard floor, etc.) or objects (ex. clothing, shoes, throw rugs, etc), and frequency of use. Be specific and detailed.*A house/room map of your home would be helpful. The house/room map should indicate all locations of soiling, all litter boxes and any outside windows or doors near areas of soiling.Did a change coincide with the onset of soiling? (Check all that apply) Another pet added or left Another pet died Kitty had an illness or surgery Family member came or left Marriage Divorce Baby born Household move Household schedule change Post-vacation or prolonged absence of a family memberDetails of change:Did the onset of soiling coincide with a change in a relationship with another cat, animal or person inside or outside the household?*YesNoGive details:*What day-to-day circumstances or stimuli do you associate with he soiling incidents? (Check all that apply) Occurs while you're at work Occurs during or following a person's prolonged absence such as a trip Occurs when a neighborhood cat is hanging around outside Occurs after a neighborhood cat enters through the cat door Occurs following confrontation with another pet in the household Occurs following fighting involving other household pets Occurs following family strifeGive details:Litter Box ManagementNumber of cats in the household using litter boxes:*Number of indoor litter boxes available to your cat(s):*Eliminates outdoors?*YesNoEliminates in an indoor litter box and outdoorsIf eliminates indoors and outdoors:Prefers an indoor litter boxPrefers outdoorsUses both locations equallyDo you have a dog?*YesNoHow many?*What breed(s) and/or approximate weight(s)?*Does the dog have access to the litter box or the room the litter box is in?*YesNoWhat floors of the home does your cat have access to? (ex. First floor, Second floor, Third floor, Basement, Garage, etc)What floors have litter boxes? How many?Give a location description of each litter box (ex. Litter box A: first floor laundry room; Litter box B: second floor den):Litter box A:Litter box B:Litter box C:Litter box D:Other litter box locations:In the following section, when the words "litter boxes" are followed by ** use the above alphabetical designations to answer questions for each litter box. Ex. Answer "A" for Litter box A in the first floor laundry room, "B" for the litter box B in the second floor den.Are any litter boxes near objects that create noise or move, such as washing machines, dishwashers, televisions, stored vacuum cleaners, chiming clocks, exercise equipment, etc.?*YesNoIndicate which litter boxes ** and describe:*Are any litter boxes near mirrors, windows, cat food dishes or water dishes?*YesNoIndicate which litter boxes ** and describe:*Did you change the location of a litter box or boxes prior to or after the onset of the soiling?*YesNoIndicate which litter boxes ** and describe:*Type of litter material: Scented or deodorized clumping sand-type clay litter Unscented or non-deodorized clumping sand-type clay litter Scented or deodorized "gravelly" clay (non-clumping) Unscented or non-deodorized "gravelly" clay (non-clumping) Plant-based clumping litter (ex. corn, wheat, etc.) Paper pellets Wood pellets Other plant-based pellets (ex. walnut, corn, etc.) Litter pearls or crystalsIf different, indicate which litter material is used in each litter box **.Commercial brands of litter products:Baking soda in litter or litter box**?Litter box treated** with other commercial deodorizer or additive? And, if so, what brand?Did you change the type of litter, add or stop baking soda or other commercial deodorizer prior to or after the onset of soiling?*YesNoIf so, describe the change, which litter box** and when it occurred:*Types of litter boxes: Uncovered Covered Large Plastic Storage Container (indicate dimensions) Automatic/self-cleaningIf different, indicate which litter boxes** (ex. Litter box A is covered, Litter box B is uncovered, etc).Did you change the type of litter boxes (ex. from an uncovered to a covered litter box) prior to or after onset of the soiling?*YesNoIf yes, what change did you make, which litter boxes** and when did you make the change?*Size of each litter box**:* Jumbo/Large Plastic Storage Container (larger than extra large size) Extra Large (22x18x6") Large (18x15x5") Medium (14x10x4") Small (smaller than medium size)Which litter box(es)** have plastic liners?Who regularly scoops the litter box(es)**?*If a child is responsible for scooping the litter box(es), how old is the child?Frequency of scooping stool and urine from litter boxes** (ex. once daily, twice weekly):*How often do you replace the soiled litter with fresh litter **?*How often do you wash the litter box(es)**?*What cleansers or other products are used when cleaning the litter box(es)**?*Kitty's Litter Box HabitsWhich litter box(es)** does the cat prefer to use?Which actions describe this cat's litter box routine? (Check all that apply) Gets in, digs, eliminates, turns and sniffs waste Covers urine Covers stool Leaves urine uncovered Leaves stool uncovered Stands in the litter box and urinates outside the litter box Sprays against the inside wall of a covered litter box Stands in the litter box and defecates outside the litter box Cries before urinating Cries before defecating Seems anxious, cries, moves around the litter box before getting in When using the litter box, perches on the edge, digs minimally, shakes paws after leaving the boxHas kitty varied whether it covers its urine or stool?*YesNoDescribe the variation and when it started:*Do you associate the variation with an event or change, such as the addition of another cat?*YesNoExplain:*Which is true concerning when the kitty uses the litter box? (Check all that apply) Will use the litter box in the presence of other animals Will use the litter box in the presence of people Prefers solitude when using the litter box around other animals Prefers solitude when using the litter box around peopleDoes kitty like to immediately use a freshly cleaned or scooped litter box?*YesNoAre you considering removing the problem cat from the household if the problem is not resolved?*YesNoDescribe the steps you have taken to correct the behavior. List all medications you have tried, their dosages and chronological use. Did these techniques and drugs help, under or have no effect on the problem? Which techniques and drugs helped the most?