Surgical Repair of Scrolled Cartilage of the Third Eyelid 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 authorize the repair of a scrolled cartilage of the third eyelid of the right/left/both eye(s). I understand that the third eyelid may still not stand up straight after this procedure.Has your pet ever had any seizures?* Yes No I hereby consent to this procedure on the:* Right Eye Left Eye Both Eyes Risks of the above procedure(s) include (but are not limited to) the following: 1. anesthetic complications including death 2. infection 3. refolding of the third eyelid cartilage 4. corneal ulcerationPlease Sign or Initial Below*
