Inappropriate Elimination Form | Plymouth, MI

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*** At this time we are only seeing curbside and drop off appointments ***
We are offering curbside appointments with the options of: Phone Call (speakerphone during the exam)
Video Chat via the website doxy.me (link will be provided) Drop off appointments will be contacted via phone after the exam

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.

Client's First Name*

Client's Last Name*

Phone*

Email*

Cat's Name*

How many cats do you have in your home?*

How many, and what type of other pets do you have?*

How many litter boxes do you have in your home?*

Where are all of the litter boxes located?*

What type of litter boxes do you have in your home? (i.e. covered, uncovered, automatic scooping, etc…)*

Have you recently changed the location of your litter boxes?*

Yes

Have you recently replaced any of the litter boxes?*

Yes

How big are your litter boxes?*

How deep are your litter boxes?*

How often do you scoop or change the litter boxes?*

How often do you wash or change the litter box completely?*

What do you clean the boxes with? (i.e. soap, bleach…)*

What type of litter are you using? (i.e. scoopable, clay, paper, etc…)*

The litter you use is:*

Scented

Unscented

Do you use litter box liners?*

Yes

Have you recently changed litter type or brand?*

Yes

Are you using additives in your litter such as baking soda or Cat Attract?*

Yes

If you are using additives, what additives are you using?*

How long has your cat been inappropriately eliminating?*

Where in the house is the inappropriate eliminating happening?*

How often does it occur?*

Does your cat still use the litter box at all?*

Yes

If so, for what?*

Urinate

Defecate

Both

Does your cat urinate, defecate, or both outside of the litterbox?*

Urinate

Defecate

Both

Does your cat:*

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?*

Yes

If so, please explain:

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

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

Has there been any changes in your home such as a new baby/pet, construction, moving, etc…?*

Yes

If so, explain:

Is your cat's water consumption normal?*

Yes

Do you have any aggressive pets that would chase & intimidate your cat, keeping them from the litter box?*

Yes

Have you noticed an increase in urine or stool in the litter box?*

Yes

If so, explain:

Has your cat been having diarrhea?*

Yes

If so, for how long?

Is your cat straining to urinate or crying out while urinating?*

Yes

If so, please explain:

Is your cat straining to defecate or crying out while defecating?*

Yes

If so, please explain:

What best describes your cats lifestyle?*

Indoor Only

Outdoor Only

Indoor/Outdoor

If your cat goes outside, is he/she supervised while outside?*

Yes

Has your cat's lifestyle changed since the inappropriate elimination started?*

Yes

Are there any items that your cat would have to travel over/through to get to the litter box?*

Yes

If so, please explain:

Have you noticed any new wildlife or construction near your home?*

Yes

If so, please explain:

Is your cat currently on any medication?*

Yes

If so, please list all medication, concentrations, amount given, and how often:

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

Additional Information Needed for Appointment:
Please bring a schematic of your home with you for your appointment. Have listed where the windows, doors, litter boxes, pet beds, and feeding stations are
located and the locations where inappropriate elimination is occurring. Please email photos of your litter boxes to us at [email protected] prior to your appointment.
We will see you soon!

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