New Carlisle Animal Clinic PC

8935 E. US 20
New Carlisle, IN 46552

(574)654-3129

www.newcarlislevet.com

FELINE ELIMINATION DISORDER QUESTIONAIRRE

 

Owner's Name ________________________   Pet _________________   Date ___/___/___

 

1.   Is cat spayed or neutered? _____   If so, at what age was surgery performed? ____

      If not, do you plan to use animal for breeding? ____  Has the pet been used for breeding so

      far? ___   When? ____     If cat is female, what have been the dates of her heats? _______

2.   How old was your pet when you got it?____

3.   At what age (or on approximately what date) did abnormal elimination begin? _____

4.   Has the pet lived with other owners? ___  Lived in other homes with you?____  If so, when

      did you move to this house? ____

5.   Where did you obtain the pet? _____________________________________

6.   How much time does the pet spend inside (% of its day)? ______

7.   How much time do you spend actively interacting with cat each day? ______

8.   How many other cats do you have?_____   Where are they kept? _____________________

      How many & what other types of pets do you have? ________________________________

      When did you acquire all of these pets? _________________________________________

9.   Is this cat kept penned, in an individual room or other-wise restricted, or have free reign of

      the house (& and what percent of time of each)? ___________________________________

10. Can you be certain that this is the only pet having elimination problems? ____ How so?____

11. Has the household changed since you acquired the pet? (list date of event)

      -death of household member                              -death of another pet

      -divorce                                                            -marriage

      -child born/adopted                                           -adult moved into household

      -child/adult moved out of house                          -pet added to household

      -family moved                                                   -family schedule changed (job changes)

      -other ______________________________

12.  List the number of people, their age (if children), the amount of time home each day, and how they interact with cat, that live in the household or are frequently there:_____________________

___________________________________________________________________________

___________________________________________________________________________

13.  Where does the cat sleep? __________________ Is it confined there? ____

14.  Is the cat declawed?____  Two or four feet?____  At what age was it declawed?_____

       Were there any complications during the recovery (specify)? ____________________

15.  Because of the elimination problem, are you considering "drastic" measures such as finding the cat another home, changing its living arrangements, or euthanasia?____

16.   Does the cat urinate outside the litter box? ____  How often?_________  Does he ever use

      the litter box for urination? ____ How often? ____  Does the cat defecate (stool) outside the

      litter box? ____  How often? ____  Does he ever use the litter box for defecation? ____   

      How often? ____  Are the stools normal?____ If not, describe appearance, texture, and

      frequency of abnormalities? _________________________________ Any straining to

      urinate or defecate (specify)?_________ Any discoloration of urine?___  If so, with what

      frequency?______     Date of last urinalysis/result?_____    Date of last fecal/result?____

      Does the pet vocalize to urinate? ___ defecate? ____  How much does he drink daily?___

17.  How many litter boxes do you have in total? ____

      Answer for each:   (a diagram of house with litter box locations can be helpful)

        LOCATION         SIZE               DEPTH            COVERED             LITTER TYPE

    a._________________________________________________________________________

    b. _________________________________________________________________________

    c. _________________________________________________________________________

    d. _________________________________________________________________________

    e. _________________________________________________________________________

18.  Have you changed any of the above, especially litter type, PRIOR TO the elimination behavior

       problem began? (be specific, including how soon before the behavior problem started) _____ _____________________________________________________________________________

       Have you changed anything SINCE he started doing this behavior, esp changes associated with litter boxes? ________________________________________________________________

19. How frequently do you scoop out each box?_________  How often do you change the litter

     entirely? ______  What do you use to clean the litter box? _________  When was the box

     first purchased? ______

20.  Describe how your pet uses the litter box:  (circle all that apply and add more details)

       a.  Never uses box.

       b.  No one in the house sees him use it when he does use it

       c.  Scratches litter before he goes

       d.  Scratches in box after he eliminates and covers feces/urine

       e.  Scratches in box after he eliminates but does not cover feces/urine

       f.  He stands in box but eliminates over the side of box

       g.  Stands only on edge of box.

       h.  Other______________________________________________________________

21. Describe how your pet eliminates when he fails to use the litter box

       a.  Does he eliminate within a few feet of litter box?___

       b.  He eliminates on these surfaces:   carpet     tile/linoleum    cement     cloth   ________

       c.  How close to a wall do you find urine/stool?  _____

       d.  Do you ever find urine stains on wall or other vertical surfaces (TV, cabinets, etc)?____

       e.  Describe all places where your pet has eliminated (preferably draw a diagram of the

            house and put an X on areas where he has urinated and an O where he has defecated)

            _______________________________________________________________________

       f.  Does he spray (backs up to object, twitches tail, and voids while standing)?_____

       g. Does he squat to void? _____

       h.  Alternatively to question f & g:  I never see him void out of box ____ 

 

File NameDescription / Comment
Feline Inappropriate Elimination QuestionnaireNEW CARLISLE ANIMAL CLINIC, P.C. Drs. Jerry Hans and Tracy Chase 8935 E. U.S. 20 New Carlisle, IN 46552 Tel 574-654-3129 Fax 574-654-3239 e-mail: ncanimalclinic@prodigy.net website: www.newcarlislevet.com Owner?s Name ________________________ Pet _________________ Date ___/___/___ FELINE ELIMINATION DISORDER QUESTIONAIRRE 1. Is cat spayed or neutered? _____ If so, at what age was surgery performed? ____ If not, do you plan to use animal for breeding? ____ Has the pet been used for breeding so far? ___ When? ____ If cat is female, what have been the dates of her heats? _______ 2. How old was your pet when you got it?____ 3. At what age (or on approximately what date) did abnormal elimination begin? _____ 4. Has the pet lived with other owners? ___ Lived in other homes with you?____ If so, when did you move to this house? ____ 5. Where did you obtain the pet? _____________________________________ 6. How much time does the pet spend inside (% of its day)? ______ 7. How much time do you spend actively interacting with cat each day? ______ 8. How many other cats do you have?_____ Where are they kept? _____________________ How many & what other types of pets do you have? ________________________________ When did you acquire all of these pets? _________________________________________ 9. Is this cat kept penned, in an individual room or other-wise restricted, or have free reign of the house (& and what percent of time of each)? ___________________________________ 10. Can you be certain that this is the only pet having elimination problems? ____ How so?____ 11. Has the household changed since you acquired the pet? (list date of event) -death of household member -death of another pet -divorce -marriage -child born/adopted -adult moved into household -child/adult moved out of house -pet added to household -family moved -family schedule changed (job changes) -other ______________________________ 12. List the number of people, their age (if children), the amount of time home each day, and how they interact with cat, that live in the household or are frequently there:_____________________ ___________________________________________________________________________ ___________________________________________________________________________ 13. Where does the cat sleep? __________________ Is it confined there? ____ 14. Is the cat declawed?____ Two or four feet?____ At what age was it declawed?_____ Were there any complications during the recovery (specify)? ____________________ 15. Because of the elimination problem, are you considering ?drastic? measures such as finding the cat another home, changing its living arrangements, or euthanasia?____ 16. Does the cat urinate outside the litter box? ____ How often?_________ Does he ever use the litter box for urination? ____ How often? ____ Does the cat defecate (stool) outside the litter box? ____ How often? ____ Does he ever use the litter box for defecation? ____ How often? ____ Are the stools normal?____ If not, describe appearance, texture, and frequency of abnormalities? _________________________________ Any straining to urinate or defecate (specify)?_________ Any discoloration of urine?___ If so, with what frequency?______ Date of last urinalysis/result?_____ Date of last fecal/result?____ Does the pet vocalize to urinate? ___ defecate? ____ How much does he drink daily?___ 17. How many litter boxes do you have in total? ____ Answer for each: (a diagram of house with litter box locations can be helpful) LOCATION SIZE DEPTH COVERED LITTER TYPE a._________________________________________________________________________ b. _________________________________________________________________________ c. _________________________________________________________________________ d. _________________________________________________________________________ e. _________________________________________________________________________ 18. Have you changed any of the above, especially litter type, PRIOR TO the elimination behavior problem began? (be specific, including how soon before the behavior problem started) _____ _____________________________________________________________________________ Have you changed anything SINCE he started doing this behavior, esp changes associated with litter boxes? ________________________________________________________________ 19. How frequently do you scoop out each box?_________ How often do you change the litter entirely? ______ What do you use to clean the litter box? _________ When was the box first purchased? ______ 20. Describe how your pet uses the litter box: (circle all that apply and add more details) a. Never uses box. b. No one in the house sees him use it when he does use it c. Scratches litter before he goes d. Scratches in box after he eliminates and covers feces/urine e. Scratches in box after he eliminates but does not cover feces/urine f. He stands in box but eliminates over the side of box g. Stands only on edge of box. h. Other______________________________________________________________ 21. Describe how your pet eliminates when he fails to use the litter box a. Does he eliminate within a few feet of litter box?___ b. He eliminates on these surfaces: carpet tile/linoleum cement cloth ________ c. How close to a wall do you find urine/stool? _____ d. Do you ever find urine stains on wall or other vertical surfaces (TV, cabinets, etc)?____ e. Describe all places where your pet has eliminated (preferably draw a diagram of the house and put an X on areas where he has urinated and an O where he has defecated) _______________________________________________________________________ f. Does he spray (backs up to object, twitches tail, and voids while standing)?_____ g. Does he squat to void? _____ h. Alternatively to question f & g: I never see him void out of box ____