Dental Consent Form Date * Required MM slash DD slash YYYY Client First Name * Required Client Last Name * Required Pet Name * Required Species * RequiredSelect speciesDogCatOtherBreed * Required Date of Birth * Required MM slash DD slash YYYY Age * Required Sex * Required I agree to make myself available by telephone during the approximate time interval of 9:00am to 1:00pm. * Required Yes Pre-Anesthetic Blood TestWe will perform a full physical examination on your pet before anesthesia. However, not all health issues are apparent on physical exam. Pre-anesthetic blood work is performed to detect any infection, anemia, or problems with organ function (such as liver or kidney problems). For this reason it is required for all patients. Results are immediately available and you will be notified in the event of abnormal results. I have read and understand* * Required I have read and understand. Dental Extractions and Minor Dental Surgery It can be difficult to predict if teeth need extraction when an animal is awake because tartar and movement interfere with the assessment. Severely diseased teeth can cause considerable pain and discomfort and are a source of infections for other organ systems (liver, kidney, lungs, and heart). During the dental cleaning, the teeth are evaluated, and if found to be diseased, they may require an extraction or referral to a veterinary dentist for repair. The cost of extractions varies depending on the difficulty and can range from $36 to $240 per tooth.In the event that dental extractions, minor dental surgery, or any other procedures are discovered to be necessary during my pet’s dental cleaning, I authorize the following: PLEASE CHOOSE ONE STATEMENT. * Required I authorize the attending veterinarian to do any extractions, minor dental surgery, and/or procedures deemed necessary while my pet is under anesthesia. Extractions start at $400+ Please attempt to contact me if anything other than dental cleaning is needed but proceed if I am unavailable. Please do not exceed $ _______ without contacting me first. Please contact me regarding any additional procedures. If I am unavailable, do NOT proceed. I understand that this could mean my pet will require additional procedures under anesthesia at a different time. DENTAL RADIOGRAPHS: X-rays are vital in the evaluation of your pet’s dental health to allow detection of problems that cannot be seen during an oral exam, as well as an aid in making treatment strategies and to evaluate treatment outcomes. We perform full oral radiographs on all cases. I have read and understand: * Required ORAVET DENTAL SEALANT: Oravet is a dental sealant product recommended by the Veterinary Oral Health Council (www.VOHC.org). Oravet binds electrostatically to tooth enamel, creating an invisible barrier that helps prevent plaque-forming bacteria from attaching. It has been proven to significantly reduce the formation of plaque and calculus. * Required I accept Oravet Treatment I decline Oravet Treatment Emergency Contact Phone * RequiredI have read and understand this authorization. * Required Yes Date * Required MM slash DD slash YYYY Δ
