Thank you for trusting Mobile Veterinary Imaging to perform diagnostic ultrasound and ancillary
procedures for your pet!
Our goal is to provide a safe, stress-free experience for your pet while obtaining valuable
diagnostics to develop an effective treatment plan.
In order to do so, please allow us to use our veterinary judgement and experience by consenting
to the items below.
Permission to sedate my animal if deemed necessary by the hosting veterinarian.____ (initial)
Permission to perform ultrasound of additional cavity if deemed necessary by the hosting veterinarian. ____ (initial)
Permission to perform ultrasound-guided needle biopsy if deemed necessary by the hosting veterinarian. ____ (initial)
Additional fees may be associated with the procedures listed above. Please review these with
your veterinary team.
Print name _______________________________ Date_______________
Signature _______________________________
Thank you,
- MVI team
procedures for your pet!
Our goal is to provide a safe, stress-free experience for your pet while obtaining valuable
diagnostics to develop an effective treatment plan.
In order to do so, please allow us to use our veterinary judgement and experience by consenting
to the items below.
Permission to sedate my animal if deemed necessary by the hosting veterinarian.____ (initial)
Permission to perform ultrasound of additional cavity if deemed necessary by the hosting veterinarian. ____ (initial)
Permission to perform ultrasound-guided needle biopsy if deemed necessary by the hosting veterinarian. ____ (initial)
Additional fees may be associated with the procedures listed above. Please review these with
your veterinary team.
Print name _______________________________ Date_______________
Signature _______________________________
Thank you,
- MVI team
| mvi_consent_form.pdf |
