Scheduling or Questions: 951-849-3055



Patient Name: _____________________________________________________Ultrasound Exam: _____________________Appointment Date __________________ Time _______________________Amount due at time of service: _____** You must check in 15 min prior to your appointment time**What is an Ultrasound?Ultrasound is a non-invasive, painless way to see internal structures of the body. Ultrasound produces sound waves that cause echoes that are recorded to visualize structures beneath the skin. Please bring your Insurance Card.Please bring the amount due at time of service.Please bring your completed appointment forms.Please leave all valuables at home.Please bring your doctor’s order, prescription or referral form, if your doctor gave you one.Wear comfortable clothing free of zippers, metallic buttons, snaps and jewelry.Bring pertinent prior radiology images & reports or arrange to have them sent to our office prior to appointment.Preparation – If you take medication that does not need to be taken with food, you may take the medication with a sip of water.You may continue with your normal diet and activities. AbdomenNothing to eat or drink 6-8 hours prior to the exam. Abdomen and Pelvis OR Kidney and BladderNothing to eat 6-8 hours prior to the exam, with the EXCEPTION of the following instructions:You must finish drinking 32oz of water 45 min BEFORE the exam. Use the restroom prior to drinking. Hold your bladder until the test is completed. Do not drink anything other than water.Pelvis Transvaginal - An ultrasound probe will be placed directly in the vagina, the probe is smaller than the instruments used during a pap smear. Inserting the probe is like using a tampon, the sonograoher can insert the probe for you or you may insert the probe yourself. The use of a vaginal probe is not painful. Aorta or GallbladderNothing to eat or drink 6-8 hours prior to the exam. Pelvis or OBA full bladder is required for this exam because sound waves travel better through liquid.You must finish drinking 32oz of water 45 min BEFORE the exam. Use the restroom prior to drinking. Hold your bladder until the test is completed. OB Greater than 16 weeks pregnant drink 16 oz of water. Do not drink anything other than water.Pelvis Transvaginal or OB Ultrasound - An ultrasound probe will be placed directly in the vagina, the probe is smaller than the instruments used during a pap smear. Inserting the probe is like using a tampon, the sonograoher can insert the probe for you or you may insert the probe yourself. The use of a vaginal probe is not painful.ProcedureThe technologist will explain the procedure and answer any questions you may have about the exam. A transducer, or probe, is used to project and receive sound waves. A gel is wiped onto the skin so that the sound waves are not distorted as they cross through the skin. The exam may require the probe to be repositioned and pointed in different directions. The sonographer may need to vary the amount of pressure used to push the probe into the skin.Exam DurationUltrasound exams vary in duration but they are usually completed within 30min to 1 hour.Follow UpYou may continue with your normal activities after the exam. Health Insurance BenefitsAs a courtesy Highland springs imaging center will make a reasonable effort to determine the extent to which your health insurance benefits cover the cost of this radiology exam. Any such information that we convey to you will be based upon the information provided to us by your health insurance provider. We do not guarantee the accuracy of such benefit investigation. All payment determinations are made by your insurance provider at the time of claims processing. 55499004159258343903975106th StreetRamsey REDLANDSPALM SPRINGS30162502235202nd Street30162502108201st StreetSun Lakes Blvd348297564770Sun Lakes Country Club537845066548050165088265Highland Springs Imaging Center 81 S. Highland Springs AveSuite 102951-849-3055 ................
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