Eyelid Tacking Sutures/Staples Owner's Name* First Last Pet's Name* 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: Eyelid tacking sutures/staples* Right Eye Left Eye Both Eyes I understand that the eyelid tacking sutures/staples may fail which could require additional surgery* Reset signature Signature locked. Reset to sign again Please Sign or Initial Risks of the above procedure(s) include (but are not limited to) the following: anesthesia/sedation complications including death, prolonged recovery from anesthesia/sedation.* Reset signature Signature locked. Reset to sign again Please Sign or Initial
