Client # has been diagnosed as having a hyperactive thyroid gland (hyperthyroidism). Radioiodine (I131) therapy has been shown to be an effective treatment. The therapeutic use of radioactive substances must be closely controlled and monitored by radiation safety personnel. After your cat receives the radioiodine, it is housed in a special area and all of its excrements (urine and stool) are collected and stored by trained radiation safety personnel. The expected confinement period is 3-5 days. Three to four weeks after the treatment, you should return to your normal veterinarian to recheck the thyroid and kidney function. A potential disadvantage of this treatment is that should your cat need critical care, it must be provided in the confines of the radiation ward. This area is not equipped for critical care and because of the radiation hazard; personnel cannot remain close to the patient for extended periods of time. Thus, compromises in medical treatment could arise if your cat becomes ill. Owners cannot visit the radiation ward. In the rare event your cat dies during the confinement period, your cat’s remains cannot be returned to you and must be disposed of by radiation safety personnel. Also, if your cat becomes aggressive during administration anesthesia may be required at an additional charge. The hyperthyroid state may result in increased heart rate and blood pressure causing more blood to go through the kidneys. This causes the kidneys to function more efficiently making the kidney function tests better than actual kidney function. When thyroid function returns to normal following treatment, the cat’s kidney function will return to its actual level. Thus, there is a small chance that kidney failure could be uncovered in a few days to a few weeks. I have read and understand the above conditions of treatment and give permission for radioiodine treatment. Client Signature:Date Date Format: MM slash DD slash YYYY Please initial that you have received your copy of this document.