I-131 Patient Registration Form

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WebsiteReferral from my veterinarianDrive byReferral from a friendOther



Neutered MaleSpayed FemaleIntact MaleIntact Female





Uses LitterboxGoes OutdoorsHouse soils

Outgoing/SocialNeutralShyAggressiveScaredy Cat

EmaciatedThinNormalObeseVery Obese

IndoorsIndoors/OutdoorsOutdoors OnlyBarn CatFeral/Stray

AppetiteVomitingArthritisWater IntakeKidneysHearingDiarrheaDental/TeethHeart



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.