Diet—wet food (brand name__________________________)	☐None	☐25%	☐50%	☐75%	☐100%
Diet—dry food (brand name__________________________)	☐None	☐25%	☐50%	☐75%	☐100%
Litter type: (clumping, clay, recycled paper, etc.)	_________________________________________________
How many hours each day, on average, does your cat spend indoors? (check one)	☐0–6  ☐6–12  ☐12–18  ☐18–24  ☐ Indoor Only
If you have more than one cat, what is their relationship? ☐Not Related    ☐Littermate    ☐Parent-Offspring    ☐Single Cat Household    ☐Other
Where did you obtain your cat (source)? ☐Shelter   ☐Offspring from a pet I already own(ed)   ☐Purchased from a friend ☐Purchased from a breeder   ☐Purchased from a pet shop   ☐Gift ☐Stray adult   ☐ stray/orphan kitten   ☐Other______________