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Patient Portal

Your GP/Doctor has requested that we perform an ultrasound to obtain additional information. This is a diagnostic test that uses sound waves and a computer to produce images of internal body parts. The benefit of this exam is to assist your physician with making a diagnosis. There may be other imaging alternatives, however, your physician believes that a sonogram to be the best diagnostic test for you after evaluating your symptoms and medical condition at this time.

I hereby give the Permission to perform a Transvaginal Ultrasound, a study that requires the insertion of a probe into the vaginal canal to to further aid the visualisation of the anatomy of the female pelvis.

This procedure is not painful but may feel uncomfortable but you can stop the scan at any time.
1. The purpose, procedure and risks of this procedure have been explained to me.
2. I understand that I can terminate the procedure at any time
3. I understand that I am responsible for immediately telling the Sonographer if I am having any discomfort and/or unusual symptoms during the procedure.
4. I hereby give the Sonographer the Permission to perform a Transvaginal Ultrasound. I have read this consent form and understand its terms, and I am signing it knowingly and voluntarily.

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