Clio Animal Hospital 3474 W. Vienna Rd. Clio, MI 48420 Phone: (810) 687-1972 Fax: (810) 687-2324 www.clioanimalhospital.com Find us on Facebook FELINE HOUSESOILING HISTORY Date: ______________________ Pet Name: __________________________ Client Name: ____________________________ How many cats live in the home? _______ How many litter boxes? ________ Type of pans: Open Covered Small Large Deep Shallow Liner Other _____________ Type of litter material: Clumping Plain clay Deodorized/Scented Shredded paper Pelleted newspaper Other ______________ How often do you scoop the litter pan(s)? _______________________________ How often are the pans dumped/changed? ____________________________ How often is the pan itself cleaned? ____________________________________ Is there aggression between multiple cats (growling/hissing/swatting, etc)? ________________________________________________________________________ Where are food and water dishes kept? ________________________________ Where do your cats sleep? _____________________________________________ What is the primary problem? Urinating outside the litter box Defecating outside the litter box How long has this been going on? ______________________________________ Why do you think it started? ____________________________________________ Is there any history of urinary infections or medical problems? ________________________________________________________________________ Has your cat ever consistently used the litter box? _______________________ Have you ever caught your cat in this behavior? ________________________ Was there any punishment given? How did you react to the behavior? ________________________________________________________________________ For Inappropriate Urination What surfaces / material(s) does your cat urinate on? ________________________________________________________________________ Is the urine on a horizontal or vertical surface? ___________________________ Is it one large spot or multiple smaller spots? _____________________________ Is there any unusual color or odor? ______________________________________ How often is this happening? ___________________________________________ For Inappropriate Bowel Movements Are stools of normal color and consistency? If not, describe. ________________________________________________________________________ What surfaces / material(s) does your cat inappropriately defecate on? ________________________________________________________________________ How often is this happening? ___________________________________________ Please make a detailed diagram of your home. Include windows, doors, locations of food/water dishes, litter pans, and where inappropriate eliminations are occurring.