Your pet will be getting an ultrasound study today, done by a board-certified radiologist. Their schedule can be quite variable, as emergencies can arise, causing them to have to alter their planned route and schedule to handle this emergency. As a result, they request that your pet be dropped off in the morning here, so your pet can be available when do they do come. They also request that you not be present at the time of the exam. Any questions that you may have will be answered by our doctors. This allows the radiologist to be most efficient with their time so that they may be able to help and serve as many patients and clients as possible. Thank you for your cooperation!

I give permission to do a fine needle aspirate and/or biopsy, if my doctor feels it is necessary at the time of the ultrasound study. I understand there will be additional fees, as explain above. *

I give permission
I do not give permission

Please select one of the following options *

I would like to be called for permission before performing a fine needle aspirate or biopsy. I will be available at the following telephone number(s) listed below. If I am not available to talk at that time, I understand that nothing additional will be done, and that I may have to bring my pet back in another day if it is determined that an aspirate or biopsy is needed. I understand there will be another hospitalization fee, in addition to the aspirate and/or biopsy fee, the lab fee, and possibly another, reduced ultrasound fee.
I would like to be called for permission before performing a fine needle aspirate and/or biopsy. I will be available at the following telephone number(s) listed below. If I am not available to talk at that time, I give permission to perform a fine needle aspirate and/or biopsy.

Primary Telephone Number *

Secondary Telephone Number

I give permission to sedate or anesthetize my pet if the doctor feels it is necessary to safely do that ultrasound and/or the aspirate and/or biopsy. I understand without this authorization, the ultrasound, aspirate, or biopsy may not be done if the safety of the pet or the staff is at risk. *

I give permission
I do not give permission

Name *

Email *

Phone *

Signature *

Date *

Arroyo Animal Clinic

Ultrasound Consent Form

Vet Near Sunnyvale, CA

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