Consent Forms for Interventional Radiology Procedures

Please feel free to print out and read the consent form for your procedure. You do not have to bring these forms with you to your appointment; we will have copies for you to sign when you arrive.

NOTE: These forms require free Adobe Acrobat Reader.
Click here to download the latest version.

Each consent form explains the procedure, its risks, and alternatives.

• Arteriography and Possible Angioplasty, Stent Placement or Lytic Therapy

• Chemoembolization of the Liver

• Creation of a Transjugular Intrahepatic Portosystemic Shunt (TIPS)

• Dialysis Fistulogram and Possible Angioplasty, Stent Placement or Thrombolytic Therapy

• Inferior Vena Cava (IVC) Filter Placement

• Interventional Radiology Procedure (General)

• Percutaneous Biliary Drainage and Possible Stricture Dilation, Stent Placement or Stone Removal

• Percutaneous Feeding Tube Placement (Gastrostomy, Gastrojejunostomy, Jejunostomy)

• Pulmonary Arteriogram and Possible Lytic Therapy, Thrombectomy or Stent Placement

• Vascular Embolization

• Venography and Possible Angioplasty, Stent Placement or Lytic Therapy

• Venous Access Device Placement (Port, Tunneled or Nontunneled Catheter)

	Need an appointment? Request one online 24 hours/day, 7 days/week or call 800-789-PENN (7366) to speak to a referral counselor.