Phone
Email *
Patient's name: *
Breed:
Weight (lb/kg):
If your cat is castrated or spayed [neutered] at what age was this done? (specify in weeks or months) *
Age in weeks at which your cat was adopted? (specify in weeks or months) *
How long have you had this cat? *
What types of litter do you use? *
How often do you change the litter box completely (specify if monthly or weekly)? *
How often do you scoop the box? (specify if daily or weekly) *
Urine—where specifically?
Feces—where specifically?
Both—where specifically?
If you answered yes, where specifically?
Where is the cat urinating that you find undesirable (list all areas)?
How many times per week is the cat urinating in places you find undesirable?
At what time of day is the urination occurring?
Is the pattern different on days when you are home and days you are not home?
Are you at work during the hours when the cat urinates?
How many times per day does your cat usually urinate when he or she is not urinating in places you find undesirable?
Where is the cat defecating that you find undesirable (list all areas)?
How many times per week is the cat defecating in places you find undesirable?
At what time of day is the defecation occurring? *
Is the pattern different on days when you are home and days you are not home?
Are you at work during the hours when the cat defecates? *
How many times per day does your cat usually defecate when he or she is not defecating in places you find undesirable?
If you answered yes, what objects—specifically—does the cat destroy? Please list all of them and note which are destroyed when you are home or not home.
If you answered yes, to whom is this behavior directed?
If you answered yes, what is/are the vocalization(s) and when do they occur?
If you answered yes, what does the cat do and when does he or she do it?
If you answered yes, why?
If you answered yes, why?
If you answered yes, why?
If you answered yes, which animals and where?
If yes, what happened?
If you answered yes, what are these changes?
If you answered yes, what changes have occurred?
If you answered yes, what changes have occurred?
If you answered yes, what did they say?
If you answered yes, why—what did the cat do that made them say this?
If you answered yes, please list these behaviors below:
