Removal of Eyelid Mass while Awake Owner Name* First Last Pet 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: Surgical removal of eyelid mass(es)* Right Eye Left Eye Both Eyes I want the mass sent out for biopsy (If you select NO, the sample will be discarded and unable to be sent out.)* Yes No N/A I understand that the surgery may need to be repeated if there is regrowth of the mass.* Yes No Risks of the above procedure(s) include (but are not limited to) the following: sedation complications including death, infection, regrowth of eyelid mass, corneal ulceration, change in appearance of eyelid.Please Sign or Initial Below*
