Enucleation - Surgical Consent Form

  • Please Read and Respond

    I 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:
  • Please Sign or Initial
  • 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) 5. rejection of silicone implant
  • Verification of the Cost Structure

    I understand that because of unforeseen circumstances, the cost of rendered services may exceed the above estimate. In this case, all charges are held as low as possible. The doctors and staff of Animal Eye Care will be glad to go over itemization and explain any charges. I understand that it may be necessary, during the procedure or hospitalization, to provide emergency medical care in the event that I cannot be contacted. Therefore, I consent to and authorize the performance of such medical or surgical interventions as are necessary and desirable in the exercise of the veterinarian’s professional judgement. I also authorize the use of appropriate anesthetics, and other medications, and I understand that hospital support personnel will be employed as deemed necessary by the veterinarian.
  • Please Sign or Initial
  • Please Sign or Initial