Your pet is having an ultrasound examination today, which has been requested by your family veterinarian. The ultrasound examination will be done to look for any abnormalities in your pet. Typically, your pet will be taken to have the ultrasound examination while you wait. Occasionally, you may be asked to leave your pet for a longer period of time.

Any medical procedure can have complications. Complications of ultrasound examinations are very rare. Examples of risks of sedation, if necessary, include hypotension and drug reaction. Some medical conditions/diseases may put your pet at risk for complications if they need to be sedated. Examples of such conditions include: heart, kidney or liver disease, neurologic conditions that can cause seizures, certain types of cancer, pancreatitis, anemia, and excessively high or low blood pressure, among others. If you have any concerns regarding the above risks, please discuss with your family veterinarian.

Please affirm below that you understand the procedures to be done and the possible risks and complications (see below).

I give consent for the procedure and am aware of the following:

• Your pet will be clipped (shaved) for the procedure.
• As with all diagnostic procedures, ultrasound may not always provide a diagnosis.
• All communication will be through your family veterinarian.

Following the procedure today, please contact your family veterinarian to discuss the results and plan.