Name First Last PhoneEmail Is your cat urinating in the litter box at all? Yes No Where else is he/she urinating?Does he/she defecate in his box? Yes No Is he Spraying (Backing up against a wall or vertical structure) or Squatting?Have you noticed if he/she is straining? Yes No Have you seen blood in the urine? Yes No When did you first notice a problem?Is he drinking more water than usual? Yes No How many cats are in your household? Yes No How many litter boxes do you have? Yes No Which kind of litter do you use? Clumping Non-Clumping How often do you scoop the litter box? Daily 2x Daily Weekly Other How often do you clean all the boxes? Daily 2x Daily Weekly Other Did you recently change litter brands? Yes No Do the litter boxes have hoods? Yes No Do the litter boxes have liners? Yes No Have you recently moved? Yes No Any new stresses in you life, such as a new pet, new baby, new job schedule, etc? Yes No Is your cat displaying other signs? Weight loss Listlessness Vomiting Diarrhea Appetite loss Other Please list ALL foods you feed your cat?Which do you prefer to give your cat? Liquid Tablet Does your cat go outdoors/or any of your cats? Yes No PhoneThis field is for validation purposes and should be left unchanged.
