Authorization to Enter the Veterinary Hospital MRI Facility

To be able to enter the MRI Facility, you must first watch the MRI safety program video titled MRI Safety Video for Non-MRI Personnel which is on the Purdue University Veterinary Hospital web site. This video is only 20 minutes long. Once you have watched the video, you must then print off this authorization page and sign and date it. The signed form must be turned into the Veterinary Hospital Administrative Office where it will be kept on file. This mandate is for your protection and the protection of the patient that is having the MRI done. Please make sure that you listen closely to what the video says and that you remember to remove anything on your body that is metallic or ferromagnetic. Examples of what should not be taken into the MRI room are on the poster that is posted in the MRI control room. Please also be aware that space is limited in the MRI control room and so you might not be able to be in that space if your help is not needed in monitoring the patient.

This is to certify that I have watched and understand the MRI Safety Program video that is located at the above stated URL.