Ultrasound Consent Form

Ultrasound Consent Form

Ultrasound Consent Form
Name
Name
First
Last
Microchipped
Spayed/Neutered
Your pet will be having an ultrasound study today. The specialist's schedule can be quite variable, as emergencies can arise, causing them to have to alter their planned route and schedule to handle this emergency. As a result, the specialist requests that your pet be admitted in the morning here, so your pet can be available when they arrive. They also request that you not be present at the time of the exam. Any questions that you may have will be answered by our doctors. This allows the specialist to be most efficient with their time so that they may be able to help and serve as many patients and clients as possible. Although the ultrasound may be completed earlier in the day, the doctor may not be able to do communication until later in the evening and your pet may not be able to be discharged until later as well. Thank you for your understanding!

You should bring your pet between 7:30am and 8:00am. Your pet should be fasted from the previous evening 12:00am, unless instructed otherwise. Water through the night is OK. Please be aware that the Ultrasonographer will arrive any time between 8am and 4pm. Please be aware that discharge times may be as late as 5pm-7pm.

Fine needle aspirates, cytologies and sedation are an additional cost. Some pets require anesthesia or sedation in order to perform the study (the patient needs to be quite still in order to get accurate, diagnostic images and/or to obtain samples). Please ask the technician for an updated cost associated with above procedures.

Please read the following and select accordingly
I understand that nothing additional will be done if I am unable to be reached, and that I may have to bring my pet back another day if it is determined that an aspirate is needed. I understand that there will be additional charges associated with aspirates, the lab fee, and possibly another (reduced) ultrasound fee.
I give permission to sedate or anesthetize my pet if the doctor feels it is necessary to safely do the ultrasound and/or the aspirate.

I, the undersigned, have read and fully understand the above information and procedures.