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Dental and Oral Surgery Consent Form

The staff at East Roswell Vet Hospital look forward to working with you and your pet. To save time, fill out the Dental and Oral Surgery Consent below form below.

Example: Vomiting, diarrhea, swelling, hives, etc.

Dental Procedure
This is a professional oral health exam, treatment and teeth cleaning for your pet. This procedure includes an oral cancer screening, digital dental x-rays (when indicated) which help diagnose dental and oral disorders, irrigation (cleaning the mouth with an antibiotic solution), hand and ultrasonic scaling and polishing, possible surgery based on oral exam findings, and is performed under general anesthesia.

Pre-Anesthetic Blood Profiles
In an attempt to minimize risks associated with anesthesia, we advise that pre-anesthetic blood work be performed, even for elective procedures. Since our pets cannot alert us to problems, these tests give us valuable information to help assess your pet’s health. If the results of the blood screening show any problems with the vital organs that would cause us to delay today’s procedure, we will contact you. If the test results are normal, they are still valuable as they provide us with your pet’s baseline normal results for comparison should your pet become ill in the future.

Chest Radiographs (Evaluating Heart and Lungs)
If your pet is over 5 years of age, we recommend chest radiographs be performed to evaluate the heart and rule out hidden lung problems.

Consent for Anesthesia and Sedation
While your pet is under anesthesia we maintain a constant record of vital signs including heart rate, respiratory rate, oxygenation levels, blood pressure, and temperature. This helps us to detect potential anesthetic complications early and treat them before they become life threatening. An intravenous catheter may be placed for the safety of your pet, and used as a means to deliver anesthetic medication and fluids during anesthesia. This helps to maintain blood pressure and allow administration of drugs should an emergency situation develop. Your pet’s limb(s) will be shaved in order to sterilely place the intravenous catheter. Bruising, swelling and clipper burn at the catheter site may occur.

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Consent for Dental and Oral Surgery

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An attempt to call you will be made if extractions or treatment of periodontal pocketing is recommended.
If you are unreachable, a decision will be made using our best medical judgment in your pet’s best interest (see below to accept or decline).

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Acknowledgements and Agreements

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Please enter a dollar amount of additional funds you are willing to spend and initial above.

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Financial Agreement
I understand that the treatment of my pet will be conducted with due care and in accordance with the prevailing standards of competence in veterinary medicine. I certify that no guarantee or assurance has been made as to the results that may be obtained through the course of treatment undertaken by the veterinarians and staff of East Roswell Vet Hospital. I understand that a written estimate of charges is available within reasonable time of my request, and that costs for antibiotics dispensed, pain management, additional anesthesia time and extractions may not be included on this estimate; these charges are assessed on an individual basis which may vary. In order to continue to provide the highest quality of veterinary medicine, we require payment in full at the time services are rendered. I assume financial responsibility for all charges incurred to the patient services rendered, and understand that full payment is required upon completion. I certify that I have read and understand this release, and furthermore that I assume full responsibility for all charges related to the above procedures. I am the owner (or agent for the owner of legal age) for the animal described above and I have the authority to execute this consent.

First and Last name

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ADVANCE DIRECTIVE (CPR VS DNR)

East Roswell Vet Hospital