I-131 Patient Registration Form


WebsiteReferral from my veterinarianDrive byReferral from a friendOther

ShortMediumLong


RabiesFVRCPFeLVUnsure


Neutered MaleSpayed FemaleIntact MaleIntact Female


None/PoorNormalExcessive


NoneRareIntermittentChronic


NoneIntermittentChronic


GoodPickyRavenous


Uses LitterboxGoes OutdoorsHouse soils


Outgoing/SocialNeutralShyAggressiveScaredy Cat


EmaciatedThinNormalObeseVery Obese


IndoorsIndoors/OutdoorsOutdoors OnlyBarn CatFeral/Stray


AppetiteVomitingArthritisWater IntakeKidneysHearingDiarrheaDental/TeethHeart


YesNo


YesNo

I hereby authorize Cat Specialist, to examine, prescribe for, or treat the above described cat, on this initial visit and on all subsequent visits. I assume responsibility for all charges incurred in the care of this cat. I also agree to pay these charges, in full, at the time services are rendered, unless other arrangements are made prior to treatment. I understand that if this cat must be hospitalized and treated as an in-patient, I am expected to pay these charges at the time the cat is discharged. I understand that there may be a deposit required prior to hospitalization and treatment. In case of extensive hospitalization and ongoing treatment, I understand that I may be expected to pay my cat's charges on a weekly basis.