Electroretinogram (ERG) w/Ultrasound

  • Assumption of Risks

    I am the owner or agent of the above patient and have the authority to execute this consent. I hereby consent and authorize the performance of the following procedure:
  • Risks of the above procedure(s) include (but are not limited to) the following: complications associated with sedation, which may include death, prolonged effects of sedation, elevation of third eyelid, corneal ulceration.