Abdominal Ultrasound Procedural Consent Form Date MM DD YYYY Client Name * First Name Last Name Email * Pet's Name * Primary Veterinarian/Clinic * Please read: * Abdominal ultrasonography is a non-invasive technique to image organs within the abdomen or chest. The area to be imaged must be shaved in order to provide adequate imaging, and minor irritation may occur to the skin as a consequence. Hair regrowth generally takes multiple weeks to occur, but can be more prolonged in certain pets. Fine needle aspiration is a procedure involving placement of a needle, using the guidance of an ultrasound, into an organ or mass. A sample of tissue cells is drawn into the needle, placed on a slide, and sent in to a diagnostic laboratory to look for cancer cells, inflammation, or other abnormalities. This procedure is often recommended if an abnormality is identified on ultrasound, and is the first step towards diagnosing the nature of the abnormality. Some problems are easily diagnosed via fine needle aspiration but others may not yield an answer via this technique. Fine needle aspiration is generally a safe procedure, but there is a small risk of significant bleeding from the organ or mass targeted. This risk is increased in patients that have a bleeding disorder and in certain cancerous masses, but may also rarely occur in patients that were not considered to be at increased risk, and may require intervention to stop or risk serious health complications. Sedation is often necessary to perform procedures such as abdominal ultrasound, fine needle aspirates, and other diagnostic tests. Sedation usually lasts only a few hours, but some patients are more sensitive and can remain quiet until the following day. Rarely, depending on the type of sedation used, there may be a detrimental impact on blood pressure, heart rate, or breathing that could require intervention or risk serious health complications. General anesthesia is usually not necessary for the procedures performed by Dr. Naidoo, but may rarely be required for pets that do not become adequately sedate with injectable sedatives, or to perform procedures such as bone marrow aspiration. General anesthesia requires closer monitoring as it can have more profound and detrimental impact on blood pressure, heart rate and breathing. A small risk of health complications or even death exists even in healthy patients who undergo general anesthesia. Sedation and general anesthesia, if necessary, are performed by your primary veterinary team and they may have an additional consent form to be signed. I acknowledge that I am the owner or authorized agent of the pet named above. I acknowledge that I have read and understood the risks associated with the procedures above I consent to have an ultrasound performed on my pet by Dr. Naidoo if warranted. * Please initial: I consent to the administration of sedation to my pet if warranted (If initially declined, procedures including ultrasound may not be able to be performed at this time). * Please initial I consent to have fine needle aspirations performed on my pet if deemed indicated by the results of the ultrasound. (If initially declined, a repeat visit [with additional travel fee] can be scheduled for fine needle aspiration) * Please initial: I consent to have general anesthesia administered to my pet if warranted. (If initially declined, procedures may not be able to be performed at this time). * Please initial Thank you!
