Internal Medicine: Feline Hyperthyroidism Consult Form

Radioactive Iodine Treatment (I-131)

This service is for veterinarians only. Clients seeking medical information should contact their regular veterinarian for assistance.

We do our best to respond to all consult requests in a timely manner between Monday and Thursday. We do not provide consultations on Fridays. The need to balance teaching and ongoing care of our active cases with the high volume of consult requests may delay our response. If you do not receive a response within five business days, and still require consultation, please resubmit your request.

Your Email(Required)

Most consults will be returned by email but please provide your phone number in case there are questions we have about the consult

Contact number for consult questions(Required)

Best hours to contact

Do we have your permission to ask your receptionist to interrupt you if you are with a client?(Required)

Yes

Veterinarian Contact Information

Veterinarian to contact(Required)

Clinic/Hospital(Required)

Clinic Phone(Required)

Clinic Email(Required)

Owner Contact Information

Name of the owner(Required)

First Last

Owner Phone(Required)

Owner Address(Required)

Street Address Address Line 2 City State ZIP Code

Owner Email(Required)

Information about the patient

Has this patient ever been seen by any service at NC State Veterinary Hospital?(Required)

Yes

Not sure

Patient / Pet Name(Required)

Date of Birth or Age

Breed

Weight (please specify lbs or kgs)

Gender

Date of original hyperthyroidism diagnosis?(Required)

Pertinent medical summary(Required)

Specific questions to be addressed(Required)

Upload File(s) of Patient's Medical Records(Required)

Drop files here or

Max. file size: 195 MB.