Ultrasound Consent Form

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I understand that my pet is being dropped off for an abdominal ultrasound today. The abdominal ultrasound will be performed between 9am-2pm and you will receive a call after the procedure to let you know when your pet is done and can be picked up. Results may be given to you at this time, or the doctor will review the images and call you with results by the end of the day. While our doctor has been extensively trained in abdominal ultrasound she is not a board certified radiologist. On occasion there will be abnormalities found that may require repeat imaging +/- further work up with a specialist. Our abdominal ultrasound fee is ~$400

I consent to my pet having an abdominal ultrasound

YesNo

Ultrasonography is a non-invasive technique to image organs within the abdomen or chest. In order to achieve adequate imaging a large portion of your pet’s abdomen will be shaved for better visualization and your pet needs to be fasted for ~ 12 hours. Minor irritation may occur to the skin as a consequence of shaving. Hair regrowth generally takes multiple weeks to occur, but can be more prolonged in certain pets.

I consent to having my pet’s abdomen shaved for the ultrasound

YesNo

I consent that my pet has not eaten since 10pm the night before.

YesNo

Our goal is to provide a safe, stress-free experience for your pet while obtaining valuable diagnostics. In most animals sedation is often necessary to perform an abdominal ultrasound +/- fine needle aspirates in order for the pet to remain stress-free during this procedure. Sedation usually lasts only a few hours, but some patients are more sensitive and can remain quiet until the following day. Rarely, depending on the type of sedation used, there may be a detrimental impact on blood pressure, heart rate, or breathing that could require intervention or risk health complications. If sedation is needed, they will be monitored throughout the procedure to reduce any potential complications. Sedation is at an extra fee of ~$50-70 depending on the size of your pet and the type of drugs deemed safest for your pet.

I consent to having my pet sedated if needed for their ultrasound(If declined, procedures including the ultrasound may not be able to be performed).

YesNo

Fine needle aspiration is a procedure involving placement of a needle, using the guidance of the ultrasound, into a suspected area of abnormal cells. A sample of tissue cells is drawn into the needle, placed on a slide, and sent into a diagnostic laboratory to look for abnormalities. This procedure is recommended if an abnormality is identified on ultrasound and is the first step towards diagnosing the nature of the abnormality. Some problems are easily diagnosed via fine needle aspiration, but others may not yield an answer via this technique. Fine needle aspiration is generally a safe procedure, but there is a small risk of significant bleeding from the organ or mass targeted. To help decrease the possibility of bleeding, sedation is often used to decrease the risk of movement during the procedure. The fee for this additional diagnostic procedure with lab analysis is $235 (+ sedation fee above). Results typically come back in ~2-3 days.

I consent to having a needle aspirate done if deemed warranted by the vet.(If initially declined, a repeat visit at an additional cost can be scheduled for this).

YesNo

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