Date* MM slash DD slash YYYY Client Name* First Last Patient name* PhoneEmail Time methimazole was last given Methimazole dose given Time of last meal Is patient readily taking the medication? If a pregnant or potentially pregnant person is handling this medication, is she wearing gloves? Current diet (including brand, amount, frequency of meals):Has your pet experienced any of the following (please circle if yes) Anorexia Vomiting Itchiness Swelling Lethargy Depression Skin Lesions Are hyperthyroidism symptoms (excessive appetite, hyperactivity, anxiousness, excessive water consumption, excessive urination, vomiting/diarrhea, unthrifty hair coat) controlled?What questions or concerns do you have about managing your pet’s condition?
