Client Name Patient Name PhoneEmail Is the cat urinating outside the box? Yes No Where? How long has she been going there? Is the cat defecating outside the box? Yes No Where? How long has he/she been going there? How many litters boxes are there? How many of the litter boxes are covered? Where are the boxes? What kind of litter do you use? Scoopable (sand-like that clumps when wet) Clay (larger pieces that do not clump when wet) Other Check all that apply and please list the brand and if the litter is scented of unscented below.Please list the brand and if the litter is scented or unscented. Please list the brand and if the litter is scented or unscented. Please list the brand and if the litter is scented or unscented. How often do you scoop out the litter box? How often is the box completely emptied and fresh litter put in? Are liners used? Yes No Are liners scented? Yes No How deep is the litter in each of the boxes? (Approximate inches) Are deodorants such as baking soda used in the box? Yes No Please describe: How many cats in the household are using these boxes? What does the cat do in the litter box: does he/she go in and out several times before voiding, does he/she dig in or outside the box? Have you changed types of litter being used in the past six months? Yes No Please describe: Have you changed brands of litter in the past six months? Yes No Please describe: Have you seen the cat going outside the box? Yes No Third Choice Please describe what he/ she is doing. Have there been any changes to the household in the past few months? Yes No Describe How many cats are in the household? How many dogs are in the household? Is the cat acting aggressive to other members of the house? Yes No Is the cat acting aggressive to other pets in the house? Yes No If your cat is acting aggressive, please describe the behavior below:Do you have any other behavioral concerns about your cat? Yes No Please describe:PhoneThis field is for validation purposes and should be left unchanged.
