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Here is the inappropriate inside elimination questionnaire that I use for remote house training consultations. I use this form to determine the root cause.

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Inappropriate Elimination Worksheet- for dogs that were previously house trained and inside elimination represents a change in behavior.

Have medical tests been conducted since the onset of the inappropriate elimination behavior(s) for the specific goal of identifying or ruling out a medical cause(s) for the behavior(s)? 

Yes No

How long has the problem behavior been occurring?

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How often does the behavior occur?

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Is the number of incidents increasing in frequency? Yes No

Behavior occurs only in the (visible) presence of persons yes no

Behavior occurs only in the absence of persons: yes no

Behavior occurs both in the presence of and in the absence of persons: yes no:

Were there changes in the external environment that coincided with the onset of elimination disorder? (i.e. new/remodeled home, moved furniture, installed fencing (including ‘invisible’ fencing), added room mate, schedule change, added pet, lost pet, lost room mate, etc.)

Yes No

If yes to above question, please explain.

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Was there a change in dietary and elimination environment at or after the onset of the behavior? (type/brand/amounts of food recently changed, water consumption change, location of outside area used for elimination, willingness to go outside, etc.)  Yes No

If yes, please explain._______________________________________________________________________

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Are there any other behavioral changes you have noticed at or after the onset of the problem elimination? (destructive behaviors, barking, mounting, object stealing, tail chasing, shadow stalking, storm phobia, firework or noise phobia, eating non-food items, etc.)  Yes No

If yes to the above question, please explain.

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Does the problem behavior occur more often in any particular location(s)? Yes No

List area(s) of most recent problem elimination and flooring type. (i.e. inside crate in den, kitchen on tile floor, back bedroom on carpet, living room curtains on carpet, cabinet in kitchen on tile floor, etc.)

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Please check the type(s) of elimination occurring inside.  Urination Defecation

If defecation selected in previous question, circle the consistency of stool.

Hard Soft but firm Firm then partially liquid Diarrhea Variable

Will the dog readily walk outdoors for a walk, or to play?

Yes No

Will the dog readily eliminate outdoors –on or off lead -in the presence of traffic, strangers, other dogs, loud noises, in bad weather, rain, cold, or other distractions?

Yes No Maybe _________________________________________

Where does the dog eliminate outside? List area and ground type. (i.e. back patio on concrete, back yard-anywhere on grass, backyard in designated area on grass, backyard on grass or concrete, during walks on grass, during walks on street, etc.)

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Does the dog eliminate inside regardless of schedule of outside exercise/outings and may eliminate immediately after you return indoors?

Yes No

Does the quantity of inside-the-home excretions indicate full-fledged elimination?  Yes No

Are there numerous small amounts of urine deposited inside? Yes No

Please list any additional information you feel is relevant to the inside elimination problem behavior. Thank you.

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