Walnut Creek Veterinary Clinic

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402-505-5445

Ultrasound Consent

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Ultrasound Consent

I am the owner (or agent for the owner) of the above described animal and have the authority to execute this consent.

I hereby consent and authorize the performance of the following procedure: ULTRASOUND

* this will require an abdominal and/or chest area to be shaved

* this may also require a sedative to help your pet relax during the procedure

* ALL RESULTS will be sent to the referring veterinarian for further follow-up instructions and diagnosis

I understand that during the performance of the foregoing procedure(s), unforeseen conditions may be revealed that necessitate an extension of the foregoing procedure(s) or different procedure(s) than those set forth above. Therefore, I hereby consent to and authorize the performance of such procedure(s) as are necessary and desirable in the exercise of the veterinarian’s professional judgment.

I also authorize the use of appropriate anesthetics and other medications and I understand the hospital support personnel will be employed as deemed necessary by the veterinarian.

I have been advised as to the nature of the procedures or operations and the risks involved. I realize that results cannot be guaranteed.

I understand that according to law my animal should have a rabies vaccination annually or according to your county requirements and that if at this time it has lapsed, I assume full responsibility for my animal and all that he/she may come into contact with.

I have read and understand this authorization and consent. I take full responsibility for payment at time of service.

Name(Required)
MM slash DD slash YYYY
I understand that during the performance of the procedure(s), unforeseen conditions may be revealed that necessitate an extension of the foregoing procedure(s) or different procedure(s) than those set forth above. Therefore, I hereby consent to and authorize the performance of such procedure(s) as are necessary and desirable in the exercise of the veterinarian’s professional judgment.(Required)
I understand that according to law my animal should have a rabies vaccination annually or according to your county requirements and that if at this time it has lapsed, I assume full responsibility for my animal and all that he/she may come into contact with.(Required)
I have been advised as to the nature of the procedures or operations and the risks involved. I realize that results cannot be guaranteed.(Required)
I authorize the use of appropriate anesthetics and other medications and I understand the hospital support personnel will be employed as deemed necessary by the veterinarian.
I understand this procedure will require an abdominal and/or chest area to be shaved and may also require a sedative to help my pet relax during the procedure.(Required)
Initial Here
Initial Here
Initial Here
Initial Here
I have been shown a treatment plan for this procedure(s).(Required)
I am the owner (or agent for the owner) of the above described animal and have the authority to execute this consent.(Required)

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