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Submit
Urination Questionnaire
Primary Owner Full Name *
Email Address *
Secondary Owner Full Name
Relationship to Primary Owner
Cat's Name *
Cat's Age *
Cat's Breed *
Cat's Sex *
Please Select
Male
Male, Neutered
Female
Female, Spayed
Household members and ages:
Other pets' species, breeds, sexes and ages:
Is your cat: *
Indoor
Outdoor
Both
If your cat goes outside, please check all that apply:
Sneaks out occasionally
Only has access to a pen or enclosure
Only has access to a fenced yard
Is free to roam
Is always supervised when outside
Is sometimes to never supervised when outside
Are there other cats in the household? *
Yes
No
What has been the duration of your cat's housesoiling?
How often does your cat urinate per day? *
How often does your cat defecate per day? *
What percentage of time does your cat urinate outside the litterbox? *
What percentage of time does your cat defecate outside the litterbox? *
Since its onset, has the frequency of housesoiling:
Increased
Decreased
Stayed the same
When eliminating, does your cat:
Squat
Stand
Both
Does your cat vocalize when eliminating? *
Yes
No
How many litterboxes does your cat have access to?
Tell us about each litterbox: *
Please indicate the location, size, whether covered/uncovered, lined, or automatic.
Type of litter used (check all that apply): *
Clay clumping
Non-clumping clay
Course granules
Fine grain silica
Course grain silica
Wood or paper pellets
Corn or wheat based
Pine based
Potting soil
Other
Is the litter: *
Please Select
Scented
Unscented
Both
How often are the litterboxes scooped? *
How often is the box replaced with fresh litter? *
What products are used to clean the litterbox? *
Has your cat's appetite increased, decreased, or is it normal?
Has your cat's drinking increased, decreased, or is it normal? *
Has the frequency of your cat's defecation increased, decreased, or is it normal? *
Has the volume of your cat's urination increased, decreased, or is it normal? *
Has your cat's energy level increased, decreased, or remained normal? *
Have there been any changes to your cat's gait, jumping, and/or play? *
Security Question *
I HAVE READ AND UNDERSTOOD THE
PRIVACY POLICY
*
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Elgin Animal Hospital
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About Us
Our Team
Careers
Hospital Tour
Hospital Policies
Pet Care
Aging Pets
Diagnostics
Healthy Start for Puppies and Kittens
New Pet Owner Information
Preventative
Senior Wellness Health Checks
Surgery
Technician Services
Online Store
Blog
Forms
Contact Us
REQUEST AN APPOINTMENT
ONLINE CONSULTATIONS
REQUEST REFILL
AFTER-HOURS EMERGENCIES