Veterinarian Referral Request - i131

Please fill out this form if you are a veterinarian referring a cat for radioactive iodine treatment (i131).

REFERRING CLINIC INFORMATION

Clinic name

Clinic phone number

Clinic email

Referring veterinarian name

OWNER CLIENT INFORMATION

Owner's name

Owner's email

Owner's phone number

Alternative contact

PET'S DETAILS

Cat's name

Date of birth

Description

Sex

Concurrent health conditions

Date of last vaccination

*Pets must have up-to-date vaccinations to qualify as a candidate for treatment.

Is this patient easy to handle without sedation?

Lab results AT TIME OF DIAGNOSIS

Note: an actual T4 reading, taken at the time of diagnosis is required for accurate dosing. If you do not have this information, please contact the clinic to discuss.

Total T4

Creat

BUN

USG

Clinical Signs AT TIME OF DIAGNOSIS ie. weight loss, increased appetite, Pu/Pd, vomiting, diarrhoea

Clinical Signs (continued)

PALPATION OF THYROID GLAND

Current Thyroid Medication

MOST RECENT LAB RESULTS

Date

TT4

Crea

BUN

USG

Note: we require these tests to be repeated within the 30 days prior to admission. If your booking falls outside this window, these tests will need to be repeated while your cat is still on thyroid medication.

Once we receive your referral, a confirmation email will be sent to you. Please reply to that email with the patient’s complete medical records, including all lab results. Our team will then contact your client directly to arrange a booking.

If you do not hear from us within a week of completion of this form, please contact VetSouth Invercargill on 03 217 6688.

Thank you for your referral.

Address

Once your referral has been received you will be sent a confirmation email from our team (not automated), please reply with copies of the patients full records including lab results. Your client will be contacted directly to organise a booking. If you do not hear from us within a week of completion of this form please contact VetSouth Invercargill, 03 217 6688.

Click here to go back to our page about radioactive iodine treatment for feline hyperthyroidism.

Pets
Farm
Equine
Our clinics
People
Contact us

Innovation & research
Careers
About us
News
Recycling
My Pet Portal

T&Cs | Privacy

Stay in touch

Get regular newsletters with vet care articles, tips on animal health and current deals on animal products.