Transvaginal Scan
Patient Information
Your doctor has requested us to perform a transvaginal ultrasound. It is important that you understand the
procedures that is associated with this examination:
Definition of Terms
- The ultrasound transducer will be placed in the vagina (the probe is sterilised)
- The transducer will be introduced with a latex / non latex type covering
- It will be necessary to move the transducer from side to side, up and down and may be swiveled to obtain images
- If you prefer, you may insert the transducer yourself, otherwise the person conducting the examination will do this
- A third person may be present during the examination acting as a chaperone, if required by the sonographer or yourself
- You may request the examination to be stopped at any time during the examination
Patient Consent
- I acknowledge that the examining doctor / clinician has explained the proposed procedure
- I have been provided with information regarding the proposed procedure
- I understand the risks and complications involved in the procedure
- I understand I have the right to change my mind at any time including after I have signed this form but, preferably following discussion with my doctor
- I have been provided the opportunity to have any questions answered
- I therefore give my consent for the transvaginal examination to be performed
