Name
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First Name
Last Name
Email
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Phone Number
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Cat's Name
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Did you adopt the cat from Madison Cat Project?
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Is the cat male or female?
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Is the cat spayed or neutered?
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How old is the cat?
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Does the cat have all of their claws?
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How long have you owned the cat?
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Does the cat spend time outside?
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Reason for surrender. Please be as detailed as possible.
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If you are moving or need placement by a particular date, please note that here.
Does the cat have any medical issues? If so please note that here.
Is the cat on any medications? If yes, please list them.
Do they require a special or prescription diet? If so, please note what they eat.
Does the cat get along with other cats?
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Does the cat get along with dogs?
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Is the cat good with children?
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Does the cat have any behavioral issues? If so, please note in detail below.
Has the cat ever bitten someone? If yes, what were the circumstances?
How do they normally spend their time? What are things they enjoy? (toys, treats, people, animals, carriers, naps, lots of play time, etc.)
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Are there things they dislike or react poorly to? (animals, children, new people, the vet, carriers, etc.)
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How does the cat react when meeting new people?
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What kind of home environment do you feel the cat would be happiest in?
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Are you looking to surrender due to litter box issues?
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If yes, you must complete the Litterbox Usage Questionnaire below in order for us to help you. If no, please scroll all the way to the bottom of page and submit.
Have you taken the cat to the veterinarian since the problem began?
If you answered “Yes”, what veterinarian/clinic did you take the cat to? Please provide as much information as possible.
Has the cat had a history of health problems that could be related to elimination problems (e.g. urinary tract problems, kidney disease, diabetes, parasites, food allergies, etc.)?
If you answered “Yes”, please describe the problem:
Is this cat (Choose all that apply)
How often does the cat not use the litterbox?
Is this the first time you've noticed this problem?
If you answered “No”, when was the last time the cat had a problem using the litter box?
If the cat is urinating outside of the litter box, what sort of posture does he or she have when using the litter box?
How many litterboxes were available to the cat when the problem started?
How many litterboxes are currently available to the cat?
Where are the litter boxes located? Please be specific (what room, what floor, near appliances, near doorways, etc?).
How many of these boxes are covered? Uncovered?
Have any of the boxes changed location lately?
If you answered “Yes”, please explain where you moved the litter box(es) to and why you moved them.
What brand of litter do you use?
Is this litter
Is this litter
Have you changed brands of litter recently?
If you answered “Yes”, please explain when and why you changed litter brands:
How often do you scoop waste from the litterbox?
How often do you completely clean the box (i.e. dump out the litter, wash the box out, and refill it with clean litter)?
Do you use litterbox liners?
Do you use any litter box additive (e.g. baking soda, fresh scent powder, etc.)?
If you answered yes, please list the name of the product.
Please list all the places the cat has eliminated inappropriately. Please be specific.
What do you use to clean the soiled area? Please list specific product names.
Are there other cats in your household?
If you answered “Yes”, please list each cat’s age, sex, and if the cat is spayed or neutered:
If you have more than one cat, is this cat the only cat with litter box issues?
If you answered “Yes”, please describe how you determined it was only this cat and not another cat who has the litter box issue:
Are there any children in the home?
If you answered “Yes”, please list the ages of the children and how the cat reacts to them.
Are there any other pets in the home?
If you answered “Yes”, please list the type of pet(s), age, sex, and if the pet(s) is spayed or neutered. Please also describe the relationship between this cat and the other pet(s).
Have there been any changes to your household or lifestyle prior to this problem. Please consider things from the cat’s point of view: new pet, new baby, guests visiting, new furniture, construction outside, new schedule, etc.
Have you tried adding litterboxes?
Number of litterboxes added and location
Have you tried cleaning the litterbox more frequently?
If yes, how frequently?
Have you tried any of the following?
Check all that apply
Please explain in as much detail as possible about the steps you have taken and selected above.
