I, the owner/agent understand that general anesthesia is required for this imaging procedure and I also understand that a contrast agent may be used in the animal listed during the course of the MRI or CT. I understand that risks and potential complications do exist with anesthesia, magnetic resonance imaging, computed topography and the use of contrast agents. These risks and potential complications include, but are not limited to: cutaneous burns, aspiration pneumonia, and / or an abnormal reaction to anesthetic or contrast agents causing anaphylaxis (potentially fatal allergic type reactions), organ failure (heart, liver, kidney), cardiac or respiratory arrest, and death. I further realize that complications may arise as a result of my animal’s condition. All of these factors may lead to a decline in medical status and a decision may have to be made regarding my animal’s resuscitation status.

I have answered these questions to the best of my ability. Understanding the risks and potential complications as described above, I authorize and consent to AVES performing advanced diagnostic imaging