Behavioral Questionnaire For Elimination Problems Client NamePatient NamePhoneEmail Is the cat urinating outside the box?YesNoWhere?How long has she been going there?Is the cat defecating outside the box?YesNoWhere?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) OtherCheck 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?YesNoAre liners scented?YesNoHow deep is the litter in each of the boxes? (Approximate inches)Are deodorants such as baking soda used in the box?YesNoPlease 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?YesNoPlease describe:Have you changed brands of litter in the past six months?YesNoPlease describe:Have you seen the cat going outside the box?YesNoThird ChoicePlease describe what he/ she is doing.Have there been any changes to the household in the past few months?YesNoDescribeHow many cats are in the household?How many dogs are in the household?Is the cat acting aggressive to other members of the house?YesNoIs the cat acting aggressive to other pets in the house?YesNoIf your cat is acting aggressive, please describe the behavior below:Do you have any other behavioral concerns about your cat?YesNoPlease describe:PhoneThis field is for validation purposes and should be left unchanged.
