Client Questionnaire - Urination Problems

Inappropriate elimination : Client Questionnaire

Thank you for filling out this questionnaire. Your answers give us the information we need to help you with house-soiling problems occurring in your household.

Please complete all fields marked with an * even if you don’t know the answer.

This is very important but it does not have to be to perfect scale. Mark all items listed below on the house floor plan so we can get a feeling for the environment where your cat lives.

  1. Litter box locations
  2. House-soiling locations
  3. Windows and doors
  4. Scratching post locations
  5. Food and water bowl locations
  6. Cat doors or flaps

Please number the house-soiling locations in chronological order in terms of when you became aware of deposits in those locations (eg, b1, b2, etc).