Cryosurgery for Removal of Distichia and Dermoid Removal - Keratectomy Owner Name* First Last Pet Name* First Assumption of RisksI am the owner or agent of the above animal and have the authority to execute this consent. I hereby consent and authorize the performance of the following procedure: Dermoid Removal* Right Eye Left Eye Both Eyes Cryosurgery for Removal of Distichia* Right Eye Left Eye Both Eyes Risks of the above procedure(s) include (but are not limited to) the following: anesthetic complications including death, infection, rupture of the cornea, continued corneal ulceration, corneal scarring, corneal ulceration, loss of eyelid pigment, the eyelids will be very swollen for 1-2 weeks, in young animals, new distichia or some regrowth of old lashes may occur necessitating repeat surgery. Please Sign or Initial Below*
