Not Using the Litterbox History Form

Not Using the Litterbox History Form

Please note that this form is not compatible with Internet Explorer. Some outdated browsers may also not be compatible.

From the Team at Cat Specialist:
We know this is a long questionnaire, but there are a lot of variables that can contribute to a cat not using the litterbox. Kitty psychology and medicine is a complex place! Your thorough answers here can help out veterinarian hone in on the problem during your cat's appointment. Just fill this out to the best of your ability and we will discuss the rest in person.

Thank you!


Neutered MaleSpayed FemaleIntact MaleIntact Female


Best FriendCompanionFeral/StrayBarn Cat/Mouser



PillsLiquidsInjectionsTransdermalUnknown - never triedCannot Medicate




NormalExcessive amountFrequent trips - many small spotsBloodyStrainingPosturing frequentlyTrying but none producedSprayingUrinating outside the litterbox (UOOB)


NormalRegularSoftDiarrheaStrainingBlood yesBlood noMucus yesMucus noConstipationHardDryUncertainDefecating outside the litterbox (DOOB)




NoYes - HairballsYes- FoodYes - FluidYes - Plants/GrassYes - WornsHard to tell - multicat household








CarpetHardwood flooringTileLaminateLinoleumClothing itemsOwner's bedPotted plantsLeather couch/seatCloth couch/seatSinkStoveBathtubOther


YesNo





Open topCoveredLiner - YESLiner - NODoor on litterbox - YESDoor on litterbox - NO






YesNo


YesNo


YesNo


YesNo


YesNo


YesNo


YesNoUnknown


YesNo


YesNo


YesNoNot applicable - no stairs


YesNo


YesNo


YesNo


YesNo


YesNo


YesNo


YesNo


I hereby authorize Cat Specialist, Inc. to examine, prescribe for, or treat the above described cat, on this initial visit and on all subsequent visits. I assume responsibility for all charges incurred in the care of this cat. I also agree to pay these charges, in full, and at the time services are rendered, unless other arrangements are made prior to treatment. I understand that if this cat must be hospitalized at Cat Specialist and treated as an in-patient, I am expected to pay these charges at the time the cat is discharged. I understand that there may be a deposit required prior to hospitalization and treatment. In the case of extensive hospitalization and ongoing treatment, I understand that I may be expected to pay my cat's charges on a weekly basis.


Date