Enucleation Form Owner's Name* First Last Pet's Name* Consent and AuthorizationI 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: Enucleation of:* Left Eye Right Eye Both Eyes I wish to have the eye(s) sent out for biopsy.* Yes No The eye will be permanently and completely removed. The eyelids will be sewn permanently shut. I understand that this is not a reversible procedure.*Risks of the above procedure(s) include (but are not limited to) the following: 1. anesthetic complications including death 2. infection of orbital area 3. swelling of orbital area 4. blindness in other eye (cats primarily) Signature*By signing I understand the risks stated above and authorize the procedure.
