Ultrasound Consent Form

We are one of the only hospitals in the Chicagoland area performing Outpatient Ultrasounds.  This has caused extensive wait times – please be patient with our staff.

This form must be submitted before your pet is eligible for today’s ultrasound.

ProcedureFee
Ultrasound Outpatient Walk-in Fee$195
Ultrasound Abdomen$370
Medical Assessment Ultrasound$190
Total$755*

*does not include additional diagnostics, which will require owner’s consent before proceeding

  • Owner Information

  • Pet Information

  • Ultrasound report should be sent to:

  • Mandatory Consent Items

    All consent items much be checked in order to submit this form and have an ultrasound performed today.
  • This field is for validation purposes and should be left unchanged.