Dental Anesthetic Consent

OWNER & PET INFORMATION

In the past 48 hours has your pet experienced any of the following?







The nature of dental care and oral surgery is that the full extent of periodontal disease is not always apparent before we have an opportunity to take radiographs. It is possible that a treatment will be recommended that was not anticipated beforehand. As a result, it is possible for the bill to vary considerably from the original estimate of the treatment plan. 

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If dental extractions or surgery is necessary, we also offer to test for existing bleeding disorders. The oral cavity has the potential to bleed significantly and underlying clotting issues that your pet may have should be identified. 

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Please select any services you would like performed while your pet is under anesthesia:



Our greatest concern is the wellbeing of your pet. Before any sedation is administered, we will perform a complete pre-anesthetic examination to identify existing medical conditions that could complicate the procedure and compromise your pet’s health. There is always the possibility that a pre-anesthetic exam alone will not identify all health problems. This is why blood testing is required prior to anesthesia. This does not guarantee the absence of anesthetic complications. It may, however, greatly reduce the risk of complications as well as identify medical conditions that could require treatment. Comprehensive Blood Panel: This is the most complete blood screen available using our in-hospital laboratory. This panel includes red blood cell counts, white blood cell counts, a check on kidney and liver function, electrolyte levels, and an additional pancreatic function test. If your pet has not had a comprehensive blood screening performed and reported as ‘normal’ within three months of their scheduled anesthesia/sedation, this test will be run the morning of their procedure.

 

I, by completing this form, (or agent on owner’s behalf) hereby authorize Central Animal Hospital (or its agents or whoever is designated) to perform the above procedure.

 

In the event of an unforeseen emergency, we will attempt to reach you without delay. Please know that we will take every precaution to ensure that your pet is safe and healthy enough to undergo their procedures today. Any known risks will be discussed with you. However, very rarely emergencies do happen, and we want to know your preference if no one can be reached.

Please check your preference: *

ACKNOWLEDGMENTS

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