Radiologist Pre Check-In Form

Radiologist Pre Check-In Form

Duluth Animal Hospital
Your Name*

First NameLast Name
Pet's Name*
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Duluth Animal Hospital partners with a board-certified radiologist to help visualize internal organs in the abdomen of your pet for diagnostic purposes. Each abdominal ultrasound (sonogram) is performed only by a board-certified radiologist using the latest generation of portable abdominal ultrasounds. Our goal is to provide you with accurate, timely consultations, and give you the detailed recommendations you need to manage your pet's medical needs. You will be in contact with one of our doctors after the ultrasound report is complete and medications and/or treatment options will be discussed with you at that time.
Please list any medications your pet is currently taking :*
Policies and Payment
Pet must be dropped off BEFORE 10am on the day of ultrasound.

A deposit of $150 is required at the time of scheduling to reserve your appointment. This will be applied to your total at check-out.

Cancellation or rescheduling must be done AT LEAST 24 hours prior to appointment or deposit is forfeit.
Pets must remain still in order to capture ultrasound images. For anxious or wiggly pets, a mild sedative injection may be necessary to help them relax for the duration of the ultrasound.*

I approve administering sedative if neededI want to be called first if sedative needed
Consent to Treatment
I understand that the attending veterinarian will make every effort to contact me regarding treatment in the case of unforeseen emergencies. If unable to contact me, the staff may have my permission to proceed with lifesustaining procedures.

While I accept that all procedures will be performed to the best of the abilities of the staff at DAH, I understand no guarantee or warranty has been made regarding the results that may be achieved.

I assume full responsibility for any additional expenses incurred above. Payment is due at time of service by credit or debit card, Care Credit, or cash. Checks are not accepted.

I have read and fully understand the terms and conditions set forth.
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Radiologist Pre Check-In Form

Policies and Payment

Consent to Treatment