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.