Insight Imaging & Diagnostics Scheduling
Michael Wasserman, DVM - Sonograms with Insight
Please complete all required fields. Appointment confirmations will be sent by email within 2 hours during normal business hours.
For same-day sonogram requests, call 772-236-4519 first. Then, submit this history form.
Please select your preferred sonogram time. Current availability: 3/28, 3/29, 3/30. Starting April 1st, available full time Mon - Friday and Saturday and Sunday mornings. Once full time, There will be a new system for scheduling appointments on this form.
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Day
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Date
Hour Minutes
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PM
AM/PM Option
What sonogram request is this?
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Please Select
STAT Abdomen (Report in 2-6 hours)
Routine Abdomen (Report in 24 hours on weekdays)
Please select a drop down
Hospital Name and Doctor Requesting Sonogram
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Email address to send finalized reports:
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example@example.com, If an email is not provided, it will delay reporting times.
Patient Information
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First Name
Last Name
Age
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Species
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Breed
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Sex
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Weight (lbs)
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Is sedation approved by the client? Light sedation greatly improves image quality and reduces scanning time. This is due to the physics of sound and sometimes patient discomfort. I would recommend utilizing the sedation for same day thoracic radiographs, rectal exam, orthopedic exam, etc.
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Yes
No
No, Patient unstable, Declined by doctor
Is sample acquisition approved by the client? Complicated sampling will not be done without speaking to the referring veterinarian first.
Yes
No
Please provide a relevant clinical history, including current medications and any information pertinent to the primary reason for this sonogram. Please note that all sonograms are submitted to specialists for interpretation and recommendations.
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Primary Reason for Sonogram: Current Medications: Recent Labs: Last Fecal Test: Any other pertinent historical information:
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Notes, comments, or background for case interpretation (This will NOT be included on the report.): Please include any relevant background information, clinical concerns, or contextual details that may assist with case interpretation.
Attach any clinically relevant supplemental information, radiograph report, ecg, etc.
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