Cat Abnormal Urination Form

How many cats are in the household? *

Has your cat done this before? *

Are there stressors in the house such as dogs, new people, workers, new furniture, etc.? *

Pet's name: *

What type of heartworm and flea/tick prevention do you use? *

Phone: *

How long has your cat been doing this? *

What type of food do you feed, how much, and how often? *

Is there vocalization or straining while urinating or having a bowel movement? *

Urinating

Bowel movement

Both

Neither

Is your cat urinating or having bowel movements outside of the litter box? *

Urinating

Bowel movements

Both

Name: *

Are the litter boxes covered, uncovered, or some of each? *

Covered

Not covered

Some of each

Does your cat seem to be painful, such as limping, reluctant to jump, crying when picked up, etc.? *

If yes, what is the time and date?

How many litter boxes are in the house? *

Do you already have an appointment scheduled? *

Yes

No

Is your cat urinating on walls or flat surfaces? *

Other Forms