Dental Procedure Consent Form

Use this form to authorize dental cleanings, extractions, or other oral care procedures. It allows us to move forward safely and with your approval.

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Dental Procedure Consent Form

Notice of Risk with Anesthesia *

The use of anesthesia poses a potential health risk to your pet. To reduce the risks associated with anesthesia, a current pre-anesthetic blood profile (CBC/Chemistry Panel) is highly recommended. A blood profile can help rule our pre-existing conditions that may not be physically evident, but can lead to serious complications. This profile includes tests that check for anemia, infection, diabetes, kidney and liver function as well as any other potential underlying problems. Please choose the option that best fits your pet's needs:

Details on Extractions *

Damaged teeth cause pain and disease in the mouth and they require surgical extraction to promote good oral health and proper healing. Pets with significant periodontal disease may need numerous extractions. Every effort will be made to give an accurate estimate, however, at times complete estimates are not possible to determine until the mouth is evaluated under full anesthesia.

CPR Authorization *

In the event your pet experiences an unexpected medical emergency, such as cardiopulmonary arrest while under anethesia, immediate action is critical. Please indicate below where you authorize us to perform Cardiopulmonary Resuscitation (CPR) or if you decline such intervention.

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