Outpatient Check In Form

  • Outpatient Check In Form

  • Format: (000) 000-0000.

  • Medical Procedure & Financial Consent

    I authorize South Sound Veterinary Imaging to perform an ultrasound examination on my pet. I understand the cost is $750 and that payment is due at the time of service.

  • Fine Needle Aspirate (if recommended by the Radiologist):

    If I have selected to proceed with a fine needle aspirate (FNA) and cytology, I understand the cost is: $438 for the first site and $283 for each additional site
  • Please select one:*

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    CPR Consent

    Ultrasounds are a safe, non-invasive procedure. We do not anticipate an emergency during the procedure. In the very unlikely event of an unexpected decline in your pet’s health, we aim to respond in a manner that respects your wishes and addresses both emotional and financial considerations. Emergency CPR/Resuscitation measures may include the following procedures:

    • Establishment of an airway via insertion of an endotracheal tube
    • IV catheterization
    • Administration of IV fluids
    • Injections of medications
    • Chest compressions

    Please be aware that animals successfully resuscitated after cardiac arrest are typically in a critical and unstable condition. The management of these patients necessitates continuous monitoring and technical expertise, with an uncertain outcome.

    It is important that you know the cost of the CPR starts at $300 and the total will vary depending on your pet's needs. The cost of CPR and any further care are in addition to your current estimate. Your pet would require transfer to a local emergency and specialty center. 

    Please select one of the following options:

  • CPR Status*

  • By signing below, I confirm that I am the legal owner or authorized agent for this pet, and I consent to the above procedures and associated charges.
  • Should be Empty: