BEHAVIOR QUESTIONNAIRE / HOUSE SOILING

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.


About Your Cat


Your Cat's Behavior


Your Cat's Environment


Your Cat's Diet


Litter Box


House Soiling

How long has the house-soiling been occuring?

Years
Months
Weeks

Have you used any physical punishment in response to the house-soiling (eg, rubbing nose in the urine or stool, spanking, water pistol, shouting, confinement)?



VERY IMPORTANT: Draw a basic house floor plan on a seperate sheet of paper and bring it with you to your appointment. Mark all items listed below on the house floor plan so we can get a feeling for the enviornment where your cat lives.

a = Litter box locations
b = House-soiling locations
c = Windows and doors
d = Scratching post locations
e = Food and water bowl locations
f = 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 (e.g. b1, b2, etc).