Feline Housesoiling Questionnaire
Douds Veterinary Hospital
Owner's name
First Name
Last Name
Phone Number
-
Area Code
Phone Number
Date
-
Month
-
Day
Year
Date
Pet's Name
Do you have an upcoming appointment with us?
If so, please tell us the date and time
Is your cat urinating more frequently?
Yes
No
Have you noticed any blood in your cat's urine?
Yes
No
Is your cat straining to urinate?
Yes
No
Does your cat vocalize while it eliminates?
Yes
No
Does your cat urinate outside of the litter box?
Yes
No
Does your cat defecate outside of the litter box?
Yes
No
Does your cat target vertical surfaces?
Yes
No
Does your cat squat during the problem urination?
Yes
No
Does your cat cover its feces?
Yes
No
Does your cat perch on the edge of the litter box to urinate or defecate?
Yes
No
Is your cat allowed outdoors?
Yes
No
Is the amount voided per location large?
Yes
No
Is there more than one location involved?
Yes
No
Is the problem confined to carpeted surfaces?
Yes
No
Have there been any recent changes or stresses from your cat's perspective?
Yes
No
Has there been a recent move?
Yes
No
Has there been a change in the family, the household, or schedules of family members?
Yes
No
Have you introduced new pets within the last 3 months?
Yes
No
Does your cat spray when it is "in heat"?
Yes
No
Does your cat have easy access to the litter box at all times?
Yes
No
Is the litter you use scented or deodorized?
Yes
No
Have you changed brands of litter within the last 3 months?
Yes
No
Is the litter box hooded?
Yes
No
Is the litter box cleaned with something other than soap and water?
Yes
No
Does more than one cat use the same litter box?
Yes
No
Has your cat had any type of illness within the last 3 months?
Yes
No
Has your cat had a negative experience (medicated, punished, or scared) near the litter box?
Yes
No
Does your cat feel safe in the litter box?
Yes
No
Are there other cats in the household? If yes, then how many?
Are there other pets in the household? If so, then what kind?
How many litter boxes do you have?
Where are the litter boxes located?
How frequently are urine and feces scooped from the litter box?
How frequently is the litter in the box changed and the box washed?
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