During the procedure of cleaning ears and the treatment for ear infections, unforeseen results are rare, but may occur. For example, an underlying condition, such as inner ear infection, may contribute to the inadvertant rupture of the tympanic membrane ("ear drum") despite carefule precautions and gentleness. This can cause vestibular signs (dizziness, nausea, head tilt) which may last for weeks to months. Additionally, topical medications prescribed for ear infection may occasionally cause temporary or permanent deafness. Fortunately, the occurences of these complications are rare.

By signing below, I acknowledge I have been advised of the nature of ear cleaning and treatment, and understand and accept the risks involved. I consent to have my pet's ears cleaned and treated. While I expect all procedures to be performed to the best of the staff’s abilities, I realize that medical results cannot be guaranteed. I also understand that if complications arise, there may be additional medical care and costs required.