Informed consent for diagnostic ultrasound

Clinical informed consent form

We pride ourselves that a diagnostic ultrasound scan at Sonoscope is not “just” a scan. You will have a thorough assessment consisting of a detailed history as well as a throrough physical examination. This is then followed by a diagnostic ultrasound scan. So your ultrasound findings are never just seen in isolation but are always seen as a part of a bigger clinical picture.

Please complete our clinical information and diagnostic ultrasound consent form before your appointment

Name*

First

Last

Date of birth:*

Address: *

Street*

City/Town*

Postcode*

Phone *

Email *

Would you want us to email a copy of your clinic report to your Physiotherapist (or other health professional)?

Yes

Contact details:*

Physiotherapist*

GP*

Word of mouth*

Other*

Please describe your problem*

Diagnosis

Was there an injury?*

How long has this problem been present for?*

Have you had any investigations?*

What aggravates or eases your pain?*

Have you had any treatment?*

Please upload anything that might be helpful such as image reports as well as relevant reports from your doctor or specialist. Only one file can be attached per upload.

If you have files or images that could be helpful for us to better understand the problem that we are seeing you for then please upload them below.

10 files maximum per upload. Maximum total file size: 50MB · Allowed File Types: jpg,png,pdf,docx,doc,mp4,jpeg

Do you have any medical conditions?*

List of medications*

Declaration*

Please read the following COVID-19 specific declaration and confirm you have read and agree.

I currently do not have symptoms of COVID-19 and have not recently been in close contact with anyone who has COVID-19 symptoms.

Please make sure that all the required (*) fields have been completed otherwise the form will not submit !

If you have problems submitting the form then contact us on: 07999 923844

This field should be left blank

Injection information leaflets

Hyaluronic Acid Injections - painful area in wrist

Additional risks of corona virus during the COVID-19 pandemic

Please see below a patient information leaflet discussing the additional risks of having steroid injections during the COVID pandemic published (23.10.2020)

Meet Rob Mast founder of Sonoscope Ultrasound

Meet Rob - Our Specialist Physiotherapist/ Sonographer

Rob is a specialist Extended Scope Physiotherapist with more than 20 years experience in managing complex musculoskeletal conditions.

He uses diagnostic ultrasound as an extension of his clinical skills. He is an interventional sonographer in a busy radiology department of a central London Foundation Trust Hospital .

Also make sure you check out our Facebook and Youtube channels to keep up to speed with our latest news

Find out more about Rob

Informed consent for diagnostic ultrasound

Consult

Diagnostic scan

Ultrasound guided injection

"One Stop Clinic"

Clinical informed consent form

Injection information leaflets

Meet Rob - Our Specialist Physiotherapist/ Sonographer

Contact

Treatments

Clinic: