Ultrasound Consent Form

Thank you for trusting us with your pet’s care. We understand how much they mean to you, and our team is committed to providing gentle and expert attention during their ultrasound.

Please note that, depending on the results, additional procedures may be necessary. If so, we will reach out to discuss the best course of action. Your pet’s well-being is our top priority, and we appreciate your trust in us.

If you have any questions or special instructions, please don’t hesitate to let us know. ❤️

"*" indicates required fields

Name*

First Last

Email*

Patient Name*

Phone*

Species*

Dog

Cat

Exotic

If exotic:

At the time of the ultrasound, fine needle aspirates might be indicated, please indicate preference:*

Sedation Approved Only

Sedation and FNA Approved

Declined sedation and FNA

Authorization and Risk Assessment. Please initial after each statement.

I understand that I will assume financial responsibility for all services rendered at the time of discharge.*

I hereby authorize sedation for my pet. I understand that some risks always exist with undergoing sedation. My signature on this consent form indicates that any questions have been answered to my satisfaction. While Flowertown Animal Hospital provides the highest quality of sedation monitoring, I understand that there are rare complications, or side effects any time a sedative is administered and that I have been advised of those possibilities. I acknowledge these risks and understand that the veterinarian(s) and hospital technical staff will try to minimize such risks in every way possible. I will not hold Flowertown Animal Hospital, the veterinarians, or any staff member liable for any complications that may arise.*

Please select the one of the following:*

CPR- I authorize appropriate life saving measures. I understand and assume all financial responsibility for these additional fees that are not included in your treatment plan.

DNR- I do not wish for life saving measures to be performed. I am electing “DO NOT RESUSCITATE” status for my pet.

Date

MM slash DD slash YYYY

Signature*

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