ULTRASOUND ADMISSION FORM

I verify I am the owner (or Authorized agent for the owner) of the above named pet and authorize the above procedure to be performed. I authorize the use of sedation/anesthesia and other medication as deemed necessary by the veterinarian and understand that hospital personnel will be employed in the procedure(s) as directed by the veterinarian. 

I have been advised as to the nature of this procedure to be performed and the risks involved. I understand also that there is always risk associated with any sedation/anesthesia, even in apparently healthy animals and have discussed my concerns with the veterinarian. While I understand that all available precautions are taken, I also understand that risks and potential complications exist with sedation/anesthesia. These include, but are not limited to: abnormal reaction to anesthetic agents, organ failure, obstructed airway, regurgitation, aspiration of vomitus, nerve damage, infection and potential death. 

 I understand that it may be necessary to provide medical procedures which are not anticipated for the safety or care of my pet. I hereby consent to and authorize the performance of such altered and/or additional procedures as are necessary in the veterinarian’s professional judgment. I accept responsibility for any result in additional charges. 

My signature below indicates that I understand that my pet may spend the majority of the day at our hospital because the ultrasound specialist travels hospital to hospital, so her arrival time will vary. My signature below also indicates that I understand that sedation/anesthesia may be required in order for the ultrasound to be performed. 

I AUTHORIZE MILFORD ANIMAL HOSPITAL TO PERFORM THE SERVICES LISTED ABOVE. I RECOGNIZE THAT PAYMENT IS REQUIRED UPON RELEASE OF MY PET FROM THE HOSPITAL.