Electroretinogram (ERG) w/Ultrasound Owner Name* First Last Pet Name* First Assumption of RisksI 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:Electroretinogram or ERG (retina function test)* Right Eye Left Eye Both Eyes Ocular ultrasound* Right Eye Left Eye Both Eyes I understand my pet may be sedated for this procedure* Yes No 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.Please Sign or Initial Below*
