For Veterinarians | My Site 1

Consulting Veterinarian Information

Thank you for your interest in atomicVet Nuclear Therapy Center. We are here to serve you and your clients with I-131 therapy treatments for cats and Tin 117m osteoarthritis treatment for dogs. We strive to provide the most inclusive nuclear therapy service for your clients and return them to you for all follow-up care. Please share our website with your clients so they can review our videos and information or register online.

Please fill out the applicable form and return it to us as soon as possible with available medical records attached.

You can also call us at 501.500.5220 or email us at pennyoxford@atomicvet.net.

I-131 Printable Referral Form

Synovetin Prescreening Form

Our Brochure

I-131 Feline Consultation Form for Veterinarians

Requesting Veterinarian name and Clinic

Veterinarian Contact Phone#

Veterinarian Email Address

Clinic Contact Name

Clinic Contact Phone#

Clinic Contact Email Address

Client First Name

Client Last Name

Client Email Address

Client Contact Phone#

Client Alternate Phone #

Street Address

Street Address Line 2

City

State

Zip Code

Pet Name

Sex

Weight in #

Date of Lab Tests

T4 Result

BUN

Current dose if taking Methamizole

Date Methamizole Started

Creatinine

Electrolyte, Note abnormals

Other Notable Data

Symptoms and duration

Other Current Health or Behavior Issues

Upload all Listed Lab Test Results Here

Upload CBC Results Here

Upload Medical Records Here

Please check all that apply:

I have determined that this cat is hyperthyroid and is a candidate for I-131 therapy.

I am initiating a consultation for I-131 Therapy for this cat.

I understand that this cat will be returned to my care for all follow-up treatment.

I require additional information proir to making a consultation.

I need to know:

Signature of Veterinarian

I-131 Vet Form

Syovetin Form-Vets

Tin-117m Canine Injection for Osteoarthritis
Consultation Form for Veterinarians

Requesting Veterinarian name and Clinic

Veterinarian Contact Phone#

Veterinarian Email Address

Clinic Contact Name

Clinic Contact Phone#

Clinic Contact Email Address

Client First Name

Client Last Name

Client Email Address

Client Contact Phone#

Client Alternate Phone #

Street Address

Street Address Line 2

City

State

Zip Code

Pet Name

Sex

Weight in #

Date of Lab Tests

any meds need checked?

anything else?

Symptoms and duration

Which elbows require injection?

Upload all Listed Lab Test Results Here

Upload CBC Results Here

Upload Medical Records Here

Please check all that apply:

I have determined that this dog has osteoarthritis in the elbow joints and is a candidate for Tin-117m therapy.

I am initiating a consultation for Tin-117m intra-articular elbow injection in one or both elbow joints as indicated above.

I understand that this dog will be returned to my care for all follow-up treatment.

I require additional information prior to making a consultation.

I need to know:

Signature of Veterinarian

Veterinary Nuclear Therapy Center

Consulting Veterinarian Information

I-131 Feline Consultation Form for Veterinarians

Tin-117m Canine Injection for Osteoarthritis
Consultation Form for Veterinarians

Veterinary Nuclear Therapy Center

501.500.5220
www.atomicvet.net

Mountain Home, Arkansas 72653

Veterinary Nuclear Therapy Center

Consulting Veterinarian Information

I-131 Feline Consultation Form for Veterinarians

Tin-117m Canine Injection for Osteoarthritis Consultation Form for Veterinarians

Tin-117m Canine Injection for Osteoarthritis
Consultation Form for Veterinarians