I have read and fully understand all of the statements below. On the basis of this information, I consent to the authorized radiology services indicated for my pet. (Required)
A board certified Veterinary Radiologist (Diplomat of American College of Veterinary Radiology ACVR) will be performing and interpreting the ultrasound study today and will provide your Veterinarian with a written report of the findings to discuss with you.
Some patients may require sedation for the examination, as patients must lie quite still for 20-40 minutes. If sedation is recommended, it will be given by your regular Veterinarian and staff (or Veterinarian/staff at the clinic/hospital). I understand some risks may be associated with sedation. I also understand that if sedation is not used (or is not effective) in overtly anxious, tense, panting, obese, or moving patients, the quality of the ultrasound may be affected.
I understand that ultrasound is a diagnostic test, and may not provide a definitive diagnosis on some cases. Additional tests (blood tests, biopsies, radiographs etc) or consultation with additional specialists may be recommended by your Veterinarian to continue the evaluation and treatment options of your pet.
If abnormal tissue/organs are seen on the ultrasound, a fine needle aspirate procedure (small size needle is placed in the tissue with ultrasound guidance to obtain some cells, which are placed on a slide and sent to a Veterinary Pathologist for review) may be recommended. I understand that this is a relatively low risk procedure, however hemorrhage/complications can occur (and this risk is slightly greater in suspect cancer tissue). Aspirate results are approximately 50-90% diagnostic depending on the tissue.
In certain cases, a biopsy of abnormal tissue or organ may be recommended. This procedure is slightly more invasive and requires an anesthesia to obtain a small piece of tissue with ultrasound guidance. If this procedure is recommended, it would be scheduled for a future appointment time or referral. I understand and agree
Janet A. Nieckarz-Loeven, ACVR
Sedation Consent Name (Required)
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If you are unsure, please speak with our customer service representatives.
(Required) Sex (Required) Male Female Neutered Male Spayed Female Treatment Consent (Required)
I hereby certify that I am the owner or duly authorized agent for the owner of the animal described above and am 19 years of age or over.
I understand that some risks always exist with sedation and that I am encouraged to discuss any concerns I have about these risks with the attending veterinarian before the procedure is initiated. I understand that during the procedure(s), unforeseen conditions may be revealed that necessitate an extension of the foregoing procedure(s) that are set forth above. Therefore, I hereby consent to and authorize the performance of such procedure(s) or operation(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 that 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, including the unfortunate possibility of complications causing death. I realize that no guarantee can be made legally or ethically to me regarding the outcome of any procedure performed. I have carefully read and do fully understand this authorization and consent.
Under legislation where there are no suitable medicines specifically authorized for the treatment of a particular species or a particular medical condition in that species, a medicinal product authorized for a different medical condition, or for use in another animal species or in humans may be used for the treatment of your animal. Such products will be used only when we consider them to be the most appropriate treatment.
The risks inherent in the procedures, treatments, and sedation have been thoroughly explained to me, and I accept those risks, including sedation/anesthesia mortality or infection. I agree and understand the risks Be assured that the health of your pet is our highest concern and we will do everything possible to maintain that health. Understand, too, that your signature below indicates that you have reviewed and agree to the terms of this treatment plan. (Required) Please type your name below (Required)
Pet Information They have been fasted since midnight today. (This means no food given since 12am) (Required) They have urinated this morning? (Required) They have defecated this morning? (Required) Are they currently taking any medication (e.g. Pain medication)? (Required) Do they have any allergies or are they on any special diets? (Required) Contact Information
Please provide us with all contact numbers where you can be reached during the procedure.
In the event that I am not available to provide further instructions hereafter, I give permission to the staff to discuss further financial and medical aspects of this case on the same basis as above with the following:
Secondary Contact Name (Optional)
Treatments and Social Media If during the procedure there is a treatment not included in the estimate that the Doctor deems necessary, we will make every effort to contact you. In the event that we are unable to reach you at the contact numbers provided above, please choose a protocol for the Dr. to follow: (Required)
Please choose one.
Do they need a Nail Trim?(Additional $37.60) (Required) May we use your pet’s photo for our Facebook and Instagram pages to talk about this type of treatment? (Required) Do you use our PetDesk App? (Required) If no, have you heard about it? Would you like us to send you an invite? (Required) Sedation Consent
If this procedure involves an Anesthetic or Sedation:
By signing below, you agree that you are aware of the risks inherent with the
anesthesia/sedation and that these risks have been explained to your satisfaction by a Veterinarian.
Your signature below does not make you responsible for the charges listed above
unless performed upon the patient.
I accept and agree to the terms of this treatment plan. (Required)
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Signature for Treatment Plan
CPR Consent CPR consent - By signing this, you choose to consent or not consent to Fraserview Hospital performing CPR on your pet.
Cardiopulmonary resuscitation, or CPR, is the emergency treatment used for cardiac and/or respiratory arrest. This means that a patient's heart has stopped beating and/or the patient has stopped breathing.
DNR means “do not resuscitate”. This is a decision that resuscitation (CPR) is not to be performed.
I understand Fraserview Veterinary Hospital requires a CPR status prior to admittance of all patients so immediate action can take place in the event of cardiac or respiratory arrest. The cost of performing CPR may be up to $300. I understand that by agreeing to have CPR performed on my pet, I am responsible for paying the fees associated with this. I understand that despite the best efforts of the medical team, CPR may not be successful. If the veterinary staff, after exercising reasonable medical judgment, determines that CPR will not have a successful outcome, they will cease further CPR procedures. (Required) Client Signature (Required)
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Please type your name below (Required)