Dental Anesthesia and Oral Surgery Consent

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Anesthetic and surgical procedure(s) to be performed(Required)

What To Expect During Your Pet’s Dental Procedure (3:43) https://go.veteos.com/xkx85h

I certify that I am the owner (or the agent for the owner) of the animal listed above and have the authority to execute the consent for anesthesia/sedation +/- oral surgery/ dental extractions. I have been informed of the risk of anesthesia/sedation (i.e. reaction to the drugs being used, secondary complications due to known or unknown underlying health conditions, respiratory and/or cardiac arrest) and the procedure for which it is needed. I authorize the veterinarian(s) at Walton Way Veterinary Clinic to perform the above procedure(s). I understand that some risks always exist with anesthesia and/or surgery and that I am encouraged to discuss any concerns I have about those risks with the attending veterinarian before the procedure(s) is/are initiated.

My signature on this form indicates that any questions I have regarding the following issues have been answered to my satisfaction:

  • The reasonable medical and/or surgical treatment options for my pet
  • Sufficient details of the procedures to understand what will be performed
  • How fully my pet will recover and how long it will take
  • The most common and serious complications
  • The length and type of follow-up care and home restraint required
  • The estimate of the fees for all services
  • Any necessary payment arrangements

While I accept that all procedures will be performed to the best of the abilities of the staff at this hospital, I understand that no guarantee or warranty has been made regarding the results that may be achieved. I agree to assume financial responsibility for the fees associated with the procedure(s), and provide payment via cash or credit/debit card at the time my pet is discharged from the hospital. Depending on the type of surgery, I understand that an initial deposit may be required and pre-arranged financing options are available.

ALL ANIMALS ADMITTED MUST BE CURRENT ON THEIR ANNUAL PHYSICAL, VACCINATIONS, HEARTWORM TEST (DOGS)* & LEUKEMIA/FIV (CATS). ALL PETS MUST BE FREE OF EXTERNAL PARASITES (FLEAS & TICKS). ANYANIMAL FOUND TO HAVE PARASITES WILL BE TREATED AT THE EXPENSE OF THE OWNER PRIOR TO THE ABOVE PROCEDURE.

Should unexpected life-saving emergency care be required and the hospital staff is unable to reach me, the staff(Required)
Consent(Required)

Dental and Oral Surgery/Tooth Extraction Consent Form (under anesthesia)

While all efforts are made to preserve and support your pet’s oral health, at times, significantly diseased teeth may not become apparent until a comprehensive oral evaluation and cleaning has been performed. In these instances, extraction of the diseased/painful tooth may be the best course of action for your pet’s comfort and ongoing oral health. If the need arises, we can proceed with the appropriate care and address these issues during the planned procedure to avoid the need to schedule a separate procedure.

As the owner/agent of the above animal, I hereby give my consent to Walton Way Veterinary Clinic to perform the following procedures(Required)

I understand that during this procedure, unforeseen conditions may be revealed that necessitate an extension or variance in the above procedure. The nature of the procedure and risks involved have been explained to me and I realize results cannot be guaranteed. To avoid these problems, all patients will be screened prior to anesthesia by means of laboratory tests (e.g. bloodwork, radiographs). Walton Way Veterinary Clinic currently does not have dental radiography capabilities.

I realize that sometimes with dentistry, problems may not be revealed until a thorough oral exam under general anesthesia is performed. In this case, Dr. Vann and staff will perform treatments that are only deemed necessary and to be in your pet’s best interests. I extend authority to remedy conditions that are not known at the time the procedure is commenced.

A procedure treatment plan estimate has been presented to me and I understand that this is an estimate – it is not a guarantee of costs.

By signing below, I verify that I am 18 years or older. and have read and fully understand the terms and conditions set forth above.

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Clear Signature