Ultrasound Consent Form First Name* Last Name* Owner's Name* Pet's Name* Primary Contact Phone Number* Please select...*HomeCellWorkWe are performing an abdominal ultrasound on your pet today. Abnormalities of organs are sometimes found that would indicate the need for fine needle aspirates (FNA) to help determine a diagnosis. Some areas have very little pain sensation (i.e.liver, discrete masses, lymph nodes, spleen) and as such, a very cooperative patient may not need any sedation for aspiration of an abnormal tissue. On the other hand, some patients require sedation to keep them still during the procedure. If we do find abnormalities on the abdominal ultrasound that dictate the need for FNAs please indicate your choice by initialing ONE of the following: Proceed with FNAs without any phone call, sedation is approved if needed (additional cost: FNA - $55, Cytological evaluation by a pathologist $200, sedation if needed $30-40). Please call to discuss findings prior to proceeding with FNAs. Please be advised we will attempt to call you at the number you provided above, please try to be available by phone. Primary Contact # for today? (type cell, home, work next to it) ***If we are not able to reach you, the aspirate will not be done and it will end up costing more to have another ultrasound to do the aspirates at a later date.*** I hereby consent to and authorize the performance of such procedure(s) as are necessary in the exercise of the veterinarian's professional judgement. I understand that qualified hospital support personnel will be employed as deemed necessary by the veterinarian. I have been advised as to the nature of the procedure(s) and the risks involved. I realize that results cannot be guaranteed and that any procedure involving sedation carries a risk, although very small, of death. In such case, I authorize the following measure to be taken (refer to Resuscitative measure options form located under the online forms to see details of the following options):* No resuscitation External resuscitation Please type your Digital Signature:* Date* MM slash DD slash YYYY PhoneThis field is for validation purposes and should be left unchanged.
