Please contact us to find out more about referring patients.


VCA Referral Form

Please complete the fillable referral form located further down on the page or if you prefer, download the referral form here and email to [email protected]

 

i-131 / Radioactive Iodine Treatment

Please review our Feline Radioiodine Checklist for an idea of how to prepare for your patients appointment. Call our radiology department to schedule a consultation or if you have any questions in regards to this checklist.

We typically schedule new treatments every Monday.

Download i-131 / Radioactive Iodine Treatment

Referral Form

All fields are required unless otherwise stated

Some information is missing. Please see below for details.

(optional)
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Services Requested
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(optional)
If available, please send the following with your client; patient information to include:
  • Medical Notes/Records
  • Imaging
  • Lab Work Results
  • Treatments, including last time administered
  • X-Rays
  • Other
Guardian Details
(optional)
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Patient Details
Sex
Tentative Diagnosis/Chief Complaint
History/Physical Findings (optional)
Treatment (including medications and dosages) (optional)
Special Requests/Comments (optional)
We respect your privacy and will not share your information with other parties. For more information, see the Privacy Policy.

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