Links & Forms | My Site 1

I-131 Registration for Cat Owners

Your First Name

Your Last Name

Email Address

Contact Phone# for notifications

Can we text you?

Alternate Phone #

Street Address

Street Address Line 2

City

State

Zip Code

Your Fabulous Cat's Name

Sex

Your Cat's Veterinarian's name and Clinic

Your Cat's Veterinarian's Phone Number

Current dose if taking Methimazole

Date Methimazole Started

What are your cat's symptoms and when did this start?

Is your cat anxious or afraid of new people and situations?

Does your cat bite, scratch, or have problems using a litter box?

Please list all medications that your cat currently takes:

Please list any allergies :

What food does your cat eat at home?

Please watch our informational video

and check all boxes below:

I have watched the atomicVet informatonal video about I-131 therapy for hyperthyriod cats.

I understand that I will receive a phone call to schedule my cat's appointment and will receive detailed instructions via email.

I understand that my cat will be in the nuclear therapy facility for 4-7 days depending on radiation levels.

I understand that my cat will not be able to receive visitors during that time due to federal and state laws governing radiation exposure.

I understand that my cat cannot be near any pregnant women or anyone under 18 years old for three weeks after discharge.

I understand that my cat has to stay indoors for three weeks after discharge and cannot sleep with anyone. I will limit my time in close proximity to my cat to 30 minutes per day.

I understand that I will be given instructions to reduce radiation exposure when I take my cat home.

I have a question:

Your Signature

Synovetin Tin 117m Osteoarthritis Treatment for Dogs-- Registration Form for dog owner.

Your First Name

Your Last Name

Email Address

Contact Phone# for notifications

Can we text you?

Alternate Phone #

Street Address

Street Address Line 2

City

State

Zip Code

Your Dog's Name

Sex

Your Dog's Veterinarian's name and Clinic

Your Dog's Veterinarian's Phone Number

Does your dog have any known medication allergies or reactions?

Please list all medications that your dog currently takes:

Please watch our informational video

and check all boxes below:

I have watched the atomicVet informational video about Synovetin Tn-117 therapy for osteoarthritis in dogs

I understand that I will receive a phone call to schedule my dog's appointment and will receive detailed instructions via email.

I understand that I will pay for the Synovetin treatment in advance and the cost of the medication is nonrefundable.

I understand that my dog will receive this treatment at the atomicVet facility.

I understand that my dog will be transferred to and from the facility and will be ready to pick up after anesthesia wears off and my dog has recovered, which normally takes 2 hours.

I have a question:

Your Signature

Veterinary Nuclear Therapy Center

I-131 Registration for Cat Owners

Synovetin Tin 117m Osteoarthritis Treatment for Dogs-- Registration Form for dog owner.

Veterinary Nuclear Therapy Center

501.500.5220
www.atomicvet.net

Mountain Home, Arkansas 72653