Repair of Prolapsed Third Eyelid Gland(s) Form Owner Name* First Last Pet's Name* First Assumption of RisksI am the owner or agent for the owner of the above animal and have the authority to execute this consent. I hereby consent and authorize the performance of the following procedure:Replacement of the third eyelid gland(s)* Right Eye Left Eye Both Eyes I understand that the third eyelid gland(s) may reprolapse which could require additional surgery* Yes No Risks of the above procedure(s) include (but are not limited to) the following: anesthetic complications including death, infection, reprolapse of gland, loss of tear production, corneal ulceration.Please Sign or Initial Below*
