Ultrasound Consent Form First Name* Last Name* Owner's Name* Pet's Name* Primary Contact Phone Number* Please select...*HomeCellWorkIF YOUR PET IS GETTING AN ULTRASOUND TODAY: Abnormalities of organs are sometimes found that would indicate the need for fine needle aspirates (FNA) to help determine a diagnosis. Sedation may be necessary to aspirate any areas in question. If we do find abnormalities on the abdominal ultrasound that dictate the need for FNAs please indicate your choice by initialing the appropriate line:Proceed with FNAs without any phone call, sedation is approved if needed(additional cost: $257 and if sedation is needed $30-150 depending on weight and type of sedation needed). 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 any procedure involving general anesthesia carries a risk, although very small, of death.In such case, I authorize the following measure to be taken* No resuscitation External resuscitation Please type your Digital Signature:* Date* MM slash DD slash YYYY NameThis field is for validation purposes and should be left unchanged.
