Biopsy with General Anesthesia 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: Biopsy of (Select One):* Eyelid Conjunctiva Sclera Of (Select One):* Left Eye Right Eye Both Eyes Risks of the above procedure(s) include (but are not limited to) the following: anesthetic complications including death, prolonged effects of anesthesia, infection, Corneal Ulceration. Please Sign or Initial Below*
