I hereby authorize
8011958 CANADA CORPORATION o/a CARDIO STUDY and all associated physicians and other healthcare practitioners at
8011958 CANADA CORPORATION o/a CARDIO STUDY whose assistance is required, to perform a Graded Exercise Treadmill (Stress Test; Treadmill Test: GXT) Test.
I acknowledge that
8011958 CANADA CORPORATION o/a CARDIO STUDY and I have discussed the nature of this test, the associated benefits and potential risks, in a manger that I understand.
If any unexpected conditions are discovered during the above test, I consent to such operations, procedures, tests, and/or treatments that may be essential for the maintenance of life or vital function in addition to or in place of those authorize above.
The relative risks of performing a treadmill test are low and most often there is no problem during or after the procedure. Rare the following problems may arise:
- Injuries resulting from falling off the treadmill
- Irregularities arising with your heartbeat
- Abnormal changes in your Blood Pressure
- Heart attack or death (1/10,000 risk)
I have read the above and I understand its content. Any questions I have asked have been answered to my satisfaction.
