Ultrasound Consent

OWNER INFORMATION

Your pet is having an ultrasound examination today to look for any abnormalities that may exist. When abnormalities are seen on the ultrasound examination (examples include enlarged lymph nodes or a mass), then an aspirate or biopsy may be required. This is when a small sample of the abnormal tissue is obtained with a needle with guidance from the ultrasound.
Sedation is most often needed in order to complete the examination or to acquire samples (aspirates or biopsies). We may require that a coagulation profile be performed prior to any biopsies being attained. Any medical procedure can have complications. Complications from ultrasound examinations, sedation, aspirates and/or biopsies are rare. Possible complications of aspirates and biopsies include bleeding and infection.
Risks of sedation include possible allergic reaction and hypotension (low blood pressure). Some pre-existing medical conditions may put your pet at an increased risk for complications if sedation becomes necessary. Examples of such conditions include: heart, kidney or liver disease, neurologic conditions that can cause seizures, certain types of cancer, pancreatitis, anemia, excessively high or low blood pressure, among others.
If you have concerns regarding the above risks, please discuss with your veterinarian. By completing this form I understand that an estimate of the costs has been provided to me and I am encouraged to discuss all fees attendant to such care before services rendered. I further understand the results of the ultrasound examination may not be available for 24-48 hours post exam.

PET INFORMATION

In the past 48 hours has your pet experienced any of the following?
Has your pet had any food since midnight last night?
I verify that I am the owner (or authorized agent for the owner) of the above-named pet and authorize the following: *

ACKNOWLEDGMENTS

In the event of an unforeseen emergency, we will attempt to reach you without delay. Please know that we will take every precaution to ensure that your pet is safe and healthy enough to undergo their procedures today. Any known risks will be discussed with you. However, very rarely emergencies do happen, and we want to know your preference if no one can be reached. Please check your preference: *
Today
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