Treatment Authorization Form in Queenstown, MD | Mid Atlantic Feline Thyroid Center

Client Code*

Your cat has been diagnosed with hyperthyroidism and referred to Mid Atlantic Feline Thyroid Center for radioactive iodine treatment. This is the treatment of choice for this disease, and is considered to be a safe and effective treatment. Use of therapeutic radioactive materials requires strict compliance to state and federal standards. Release of your pet is not allowed until radioactivity levels have fallen below unsafe levels. This typically will take 72 hours, but may be shorter or longer in some cats.*

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In the event of an emergency, every effort will be made to contact you. Emergency medical care will be provided by Mid Atlantic Cat Hospital, and you will be responsible for charges associated with that treatment.*

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State law requires that you will not be allowed to visit your cat while he or she is being treated. Any personal items left with your cat will not be returned.*

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Although we expect an uneventful course of treatment, in the extremely rare event of a patient’s death while in our care, we are required by law to retain possession of the remains until there is no longer any measurable radioactivity, which is approximately 85 days. At this time the remains may be returned to the owner.*

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I understand that 24 hour care is not provided.*

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I have read and understand this authorization for treatment, and the reasons why such treatment is appropriate. I release Mid Atlantic Feline Thyroid Center and its staff from any and all claims arising out of or connected with the performance of this treatment.

As the owner or agent of this patient, I authorize Mid Atlantic Feline Thyroid Center to administer Iodine 131 to my cat and accept all financial responsibility.

Owner's Name*

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Cat's Name*

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Date*