Insight Imaging & Diagnostics Scheduling
Michael Wasserman, DVM - Sonograms with Insight
Please complete all required fields. Appointment confirmations will be made by a return phone call within 2-4 hours during normal business hours.
For same-day sonogram requests, call 862-228-1982 first. Then, submit this history form.
Please select your preferred sonogram time below. For same-day appointments, please call prior to completing this form. If scheduling for a future date, consider booking multiple cases to help maximize availability and efficiency.
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Month
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Day
Year
What sonogram request is this?
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Please Select
Abdominal Ultrasound
Echocardiogram
Please select a drop down
Hospital Name and Requesting Doctor
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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 if needed?
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Yes
No
Is sample acquisition approved by the client?
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Yes
No
Please provide a relevant clinical history, recent bloodwork and testing, 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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0/1600
Notes, comments, or background for case interpretation (This will NOT be included on the report.)
Attach any clinically relevant supplemental information, radiograph report, ecg, etc.
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