Insight Imaging & Diagnostics Scheduling
Michael Wasserman, DVM - Sonograms with Insight
Please complete all required fields. Current availability: Saturday, Sunday, Limited Mondays. I will email to confirm appointments.
For same-day sonogram requests, call 862-228-1982 in addition to submitting this history form. Please complete and include as much of the clinically relevant diagnostic workup as possible prior to the sonogram, as reports are more actionable and clinically relevant when supported by comprehensive case information.
Please select your preferred sonogram time, and I will return email to confirm the appointment.
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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
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Requesting Doctor
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Best Contact for Requesting Doctor
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Please enter a valid phone number.
Email address to send finalized reports and preliminary stat reports:
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example@example.com, If an email is not provided, it will delay reporting times.
Patient/Pet Name
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Family Last Name
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Age
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Sex
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Male Intact
Female Intact
Male Neutered
Female Spayed
Species
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Canine
Feline
Exotic
Breed
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Weight
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Is sedation approved by the client? Sedation greatly improves diagnostic imaging and the resulting interpretation by relaxing the abdominal wall. My common sedation dose is currently 2-4ug/kg of Dexdomitor IV +/- Butorphanol 0.1mg/kg IV in non-stressed patients with a tense abdominal wall. This can facilitate same day sedated thoracic radiograms, rectal exam, orthopedic exam, etc. as well.
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Yes
No
No, Patient unstable, Declined by doctor
Is sample acquisition approved by the client (examples: FNA of Masses (uncomplicated), fluid sampling (uncomplicated). Note: Complicated sampling will not be done without speaking to the referring veterinarian first.
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Yes
No
Please provide a relevant clinical history, including current medications and any information pertinent to the primary reason for this sonogram you would like the interpreter to consider in the consult.
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0/1600
Abnormal PE/Chem/CBC/UA Results and Clinically Relevant Diagnostics:
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PLEASE STATE WHETHER URINE WAS OBTAINED FREE CATCH, CYSTOCENTESIS, OR PATIENT ON ANTIBIOTICS
0/800
Notes to the Specialist (Internal Use Only – Not for Final Report): Please include any background, concerns, or context that may help with case interpretation. This section will NOT appear on the final report.
Please select a drop down regarding if you need information regarding pricing, what to expect, and the abdominal ultrasound waiver for your clients. I will provide info by email or USB Drive.
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