House Soiling FormPlease enter your email address:* Cat's first name:* Cat's last name:* How large is your cat? 0 – 10lbs 10 – 20lbs Over 20lbs Is your cat declawed? Yes No If yes, at what age were they declawed? What type of house soiling is occurring? Urination Defecation Both Has your cat been to a vet to check for a medical cause? Yes No If yes, please provide the name and phone number of the veterinarian. What, if any, was the diagnosis? If no, do you suspect there is an underlying medical issue?For example, are you noticing blood in the urine, excessive drinking, etc. How long has the house soiling been happening? Did anything in your household change when the house soiling started such as a move, new person in the home, or a new pet? How often is the house soiling occurring?If other, please explain in the next section. Daily Weekly Monthly Every few months Other If other, please explain: When does it occur (a certain time of day or night, or under certain circumstances)? Is your cat provided with a litterbox? Yes No How many litterboxes are in the house? How large is litterbox in relation to the cat? What type of litterbox(s) does the cat have access to? Covered Uncovered Automatic What type of litter do you use?(Clumping, Pine, etc.): Do you use this type consistently or does it change?How often are box(s) cleaned?If other, please explain in the next section. 1 x daily 2 x daily Every other day Weekly Other If other, please explain: Where in the home is the litterbox located? Have you tried other litters? Yes No What types? How long did you use them? Did your cat use them? Yes No What is the behavior of your cat while using the litter box?(check all that apply) Stands with all four paws in the box Stands with only back paws in the box Stands on the edge, tries not to touch litter Always covers urine/feces Rarely covers urine/feces Scratches at the wall, sides of box, or floor while covering Always looking out for other cats (may run if they come near) Urinates in one box and defecates in another Where does your cat house-soil?For example: carpet, couch, laundry, etc.What does it look like? Round puddle on floor Spray on wall Long/thin area on floor What type of surface are the incidents on? Clothing Flooring Tub/sink Bedding Furniture Flooring type: Do you have other pets? Yes No If yes, what type?Dogs, cats, other How many of each?What is their interaction like?Are you certain that it is this pet that is house soiling? Have you noticed outside cats on your property? Have you tried moving the litter box to the place that incidents happen most often? Yes No If yes, what was the result? Used the box Went right next to box Found a new spot in a different area Other If other, please explain:What steps have been taken to resolve the problem?(check all that apply) Changed location of box Changed type of litter Additives to litter (baking soda, etc.) Confinement Put food dishes in accident area Punishment Medication Used Feliway in accident areas (spray or diffuser?) Covered incident area to make it undesirable (sticky tape, foil, nubby mats, etc) Changed type of litter box Cleaned box more frequently Added another litter box Other Please specify punishment:Please specify medication:What were the results?What method/product was used to clean incident areas?Does your cat have environmental enrichment?For example: cat trees, scratching posts, toys, wand toy time, etc.Do you have any additional comments about this cat’s litter box behavior?
