Client Name Email Patient Name Please list a phone number where you can be reached today What brand of food does your cat normally eat at home (if multiple brands, please list all)?Is your cat taking any medication at the time? Yes No Please list medication and dosage.Has your cat been exhibiting any coughing, sneezing, vomiting, or diarrhea? Yes No Please DescribeAre there any other health problems, questions, or concerns you would like addressed at this time? Yes No Please DescribeWe make every effort to perform the ultrasound/echocardiogram procedures without using sedation. However, in certain circumstances sedation does become necessary. Please choose from the following options: I give permission for my cat to undergo sedation if necessary and do not need to be contacted in this event. I understand that with any procedure involving general or intravenous anesthesia there are risks present which could involve serious injury or death. Please do not sedate my cat without contacting me first. I understand that if I cannot be contacted at the phone numbers provided, then the procedure may need to be repeated at another time. ULTRASOUNDS ONLY: Occasionally, ultrasound findings will warrant a guided fine needle aspirate of one or more organs for further diagnostics. Please choose from the following options: I give permission for guided aspirates if indicated. I understand that sedation may be required for this procedure. Please do not obtain aspirates without contacting me first. I understand that if I cannot be contacted at the phone numbers provided, then the procedure may need to be repeated at another time. EmailThis field is for validation purposes and should be left unchanged.
