Surgical Repair of Entropion 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 Entropion* Right Eye Left Eye Both Eyes Risks of the above procedure(s) include (but are not limited to) the following: anesthetic complications including death, infection, continued entropion, corneal ulceration, ectropion (rolling out of eyelids).Please Sign or Initial Below*
