Hyperthyroid Cat - Patient Questionnaire

Please complete the following questionnaire to ensure the best possible care.
  • Thank you for scheduling an appointment to have your cat treated with radioiodine at our facility. In an effort to ensure the optimal treatment experience for both you and your cat, please answer the questions below.
  • Please list any drugs that your cat has received within the past year. If there is more then one drug, please click the + symbol to the right of the input field.

  • DrugDurationDate Last Administered 
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  • Previous Medical History. If there is more then one disease, please click the + symbol to the right of the input field.

  • DiseaseDate DiagnosedTreatment Performed 
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  • What Brand?Flavor? 
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  • What Brand?Flavor? 
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  • Has your cat displayed any of the following symptoms?

    You must select a option from the drop box. If no symptom has occurred please select Does Not Apply.
  • Please Note: This Questionnaire is designed to help us better understand your cat and to tailor us as much as possible to their health needs. Please make sure all information is accurate to the best of your knowledge. Thank You.