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SDEP® Animal Participant Information
SDEP® Animal Participant Information
Pet Participant Name:
(Required)
Family Name
(Required)
Rescue Name
(Required)
If not part of a rescue, please put N/A.
Are you currently fostering any pets for a rescue?
(Required)
Yes
No
Species
(Required)
Canine
Feline
Gender
(Required)
Male
Female
Is your pet spayed or neutered?
(Required)
Yes
No
Animal's Temperament
(Required)
Friendly
Nervous
Go Slow
Caution (may bite)
Other – please describe on box provided
Please choose one or more to describe the animals temperament.
If other – please describe:
(Required)
Breed
(Required)
Weight (lbs)
(Required)
(lbs)
Age
(Required)
Current Meds
(Required)
Medical Issues
(Required)
Rabies Exp. Date:
(Required)
Feline-Fvcrp Exp. Date:
(Required)
Canine-Dhlpp Exp. Date:
(Required)
Consent
(Required)
I agree to the Liability Waiver
Liability Waiver
By selecting “I agree”. I understand that my pet(s) will participate in a SDEP® event for diagnostic ultrasound screening/training/seminar. My animal will be individually examined prior to any sedation, shaved as necessary, monitored throughout the procedure and in recovery until released to my care. I will receive a report with the results of my pet’s ultrasound within 2 weeks of the event/training/seminar with the exception of the “mini scanning-only” lab.
By selecting “I agree”. I understand that SonoPath Education, LLC and or SonoPath Imaging Services LLC and or SonoPath LLC will perform the service(s) in accordance with the applicable standard of care. In consideration of SonoPath Education, LLC and or SonoPath Imaging Services, LLC and or SonoPath LLC performing the service(s), I, for myself and on behalf of my spouse, children, heirs, personal representatives, successors and assigns, hereby release, forever discharge, and agree to indemnify and hold harmless SonoPath Education, LLC and or SonoPath Imaging Services, LLC and or SonoPath LLC, and its officers, employees, directors, managers, staff, insurers, re-insurers, shareholders, subcontractors, agents, owners, and members (hereinafter, collectively, “Released Parties”), from any and all damages, judgments, claims, litigation costs, actions, causes of action, liabilities, demands, agreements, and expenses, which are in any way related to my pet’s service(s) and/or the delivery of sedation and/or anesthesia to my pet.
Name
(Required)
First
Last
I am over 18 years of age
Date
(Required)
MM slash DD slash YYYY
Full Address
(Required)
Phone Number
(Required)
Email
(Required)
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