Dental Consent Form


Fluids INCLUDED - I.V. fluids provide access in the event that emergency drugs are required. They also help to maintain blood pressure and prevent dehydration, which helps your pet feel better and recover faster from the anesthetic.
 

Pre-Surgical Blood Panel - Pre-Anesthetic bloods provide information on the ability of internal organs to cope with an anesthetic procedure and help identify underlying medical conditions, which may require treatment prior to anesthesia.
 

Pre-Anesthetic tests and intravenous fluids do NOT guarantee the absence of anesthetic complications, including death, however they may greatly reduce the risk.
 

Dental Radiographs(x-rays): It can be difficult to predict if teeth need extraction on an awake animal due to movement and plaque/tartar build up. X-rays are used to confirm the necessity for extraction of a tooth than may be diseased. We perform full oral radiographs on all cases unless otherwise discussed with your veterinarian.
 

Dental Extractions: Broken or diseased teeth can cause considerable pain and discomfort and can also be a source of infection for other organ systems(liver, kidney, lungs and heart). Often, in pets with severe periodontal disease, numerous teeth must be extracted. Your Doctor will have provided an estimate detailing how long your pets expected procedure will take.
 

Would you like a Pre-Surgical Blood Panel ($155.44)? *
Would you like us to take Full Mouth Radiographs ($190.26)? *


Additional Options for Your Convenience

If any additional minor procedures (i.e. pedicure, vaccinations, exam) are deemed advisable because it would be more economical while your pet is in clinic, we will attempt to contact you for permission to proceed at the phone number provided. If we cannot reach you at the number provided, please indicate how you would like us to proceed:
 

Please select one *


Vaccination Waiver


Acknowledgement

I hereby authorize and direct the Albert North Veterinary Clinic to provide such additional services for the patient as they deem reasonable and necessary, under emergency circumstances, including, but not limited to, the administration of emergency drugs, radiology, pathology or other diagnostic services, and hereby consent thereto.

By signing below, I hereby authorize and direct the Albert North Veterinary Clinic to perform the services I have initialed above. The risks and nature of anesthetic, including death, have been explained to me and no warranty or guarantee has been made to the result or cure. I am aware my pet may need to be shaved for medical/monitoring needs.
 


Medications

Is your pet on any medications?


Please read the following carefully: Some medications that may be sent home with your pet, after their surgery, are not in child-proof containers. Medications such as Metacam for example (for pain control), are drawn up for you in individual pre-dosed syringes. These syringes are not child-proof. One alternative is to receive a full bottle of Metacam that is in a child-proof container.
 

Please select one *


Post-Surgical Acknowledgement

It has been explained to me that if I do not use the cone or restrict my pet's exercise as directed, it could cause the incision to open, leading to additional surgery and medications at my expense. If I have any questions I will contact the Albert North Veterinary Clinic.
 

Today
Security Question *