Informed Consent for Anesthesia & Dentistry
Owner’s Name______________________Pet__________
I, being responsible for the above described animal have the authority to grant you my consent to receive, prescribe for, treat and/or operate upon my pet.
Of course there’s some risk:
This form has the simple purpose of making sure you realize that your pet needing dentistry will need to be under anesthesia, and of course anesthesia is potentially dangerous. We, of course will be very careful and attentive to your pet.
Important: one of the more common dangers with anesthesia is the possibility of aspiration. This danger is greatly reduced if your pet has an empty stomach.
Also, use this form to check off any options you want or don’t want.
Pre-Anesthetic blood work greatly reduces risk by screening for kidney and liver diseases, anemia, and diabetes: ($26) Circle: Wanted Declined recommendation
(Note: this service is included if you elect our almost everything dental package)
Dental sealants ($20) Circle: Yes Please No Thanks
(Note: this service is included if you elect our almost everything dental package)
Dental Fluoride Treatment helps harden your pet’s enamel and we recommend this treatment ($8) Circle: Yes Please No Thanks
(Note: this service is included if you elect our almost everything package)
Pain Management is an automatic and included part of our dental procedures, but we will add a small charge to your bill if we think additional pain medications are needed.
Some pets will need either an antibiotic injection or antibiotics to take home after dentistry. The initial antibiotic injection, if needed, is included in our almost everything package but is otherwise $17. Take home antibiotics are extra and the fee will depend on the size of your pet, the choice of medication(s), and the duration of treatment. Just so you know.
After carefully reading the above I have signed in agreement.
_____________________________________________date____________________
Here's a copy of the consent form you will be asked to sign prior to providing dental services for your pet. As you will see, it's purpose is simply to make sure you understand that anesthesia can be dangerous.
You need to sign that you are responsible if you elect to skip pre-anesthetic blood work which we recommend to prevent anesthetic problems.
This form has some other simple purposes; it helps keep us organized; helps us inform you of optional services, and helps ensure that you're a responsible person. That responsibility, of course, includes paying your bill. We have very low prices compared to other vets, but even so, your total bill will usually be somewhere between $110 and $200 depending on which optional services are needed. We take our medical services seriously and this form helps. Thanks
