Endoscopy Consent Form

Animal / Owner name:
Contact telephone number:
My pet has been starved for the correct lengtd of time (please give details of when last fed) Yes / No
I give permission for endoscopy images obtained by NVi to be used for advertising and training purposes including on veterinary social media sites (all identification of pet, owner and veterinary surgery are removed)  Yes / No

I understand that there is a low incidence of risk involved witd all anaesthetics and procedures such as this. I understand that endoscopy is a low risk procedure but that rarely complications have been reported (such as tearing of the body tissues).

I have read the above information and hereby give consent for my pet to undergo an endoscopy procedure.

Signed:

Date:

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