Dental Consent

Owner's First Name*

Owner's Last Name*

Pet's Name*

Best Contact Phone Number*

I give Animal Medical Salado permission to sedate/anesthetize my pet for the above listed surgery/procedure. I understand that all anesthetic involves some risk to my pet, but the Animal Medical Salado uses the safest anesthetic and techniques available. The nature of the procedure has been explained to me and I understand that results cannot be guaranteed. I understand that the attending veterinarian will make every effort to contact me regarding treatment in the case of unforeseen emergencies. If unable to contact me,

YES: I give my permission to proceed with life-sustaining procedures.

NO: I do not give my permission to proceed with life-sustaining procedures.

Initial: I understand that dental cleanings often uncover diseased teeth. I understand that the cost associated with extractions, pain medications, and antibiotics is extra and give my permission for these extractions.

Initial: I DO NOT GIVE MY PERMISSION FOR EXTRACTIONS. I understand that diseased teeth will be left in place and future procedures to remove these teeth will be extra

While I accept that 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.

I also assume full responsibility for any additional expenses incurred after the surgical procedure such as follow-up radiographs, re-check physical exams, and additional surgery due to post-op complications. I understand that these are more likely to occur when there is a failure to comply with the aftercare instructions.

A complete physical exam will be performed on your pet prior to the surgery/sedation procedure if it has been longer than 30 days since the last exam. However, this may not identify all systemic or metabolic problems. For this reason, your pet should have a pre-anesthetic blood panel to evaluate major organ function prior to anesthesia.

Bloodwork before anesthesia is an important screening tool to look for infection and dysfunction of liver, kidneys and other internal organs. Bloodwork is more affordable/complete if done prior to surgical appointment.

Initial: I understand that my pet is a senior (over 7yrs) and that the doctor requires bloodwork on these patients. The cost for this is $113 if not performed before surgical appointment.

YES, I would like preanesthetic bloodwork performed for my pet today.

NO, I decline pre-anesthetic bloodwork and know that this puts my pet at additional risk.

An intravenous catheter is an important tool to provide anesthetic and emergency medications and is often placed at the doctor discretion.

Yes, I want my pet to have a catheter ($42.50) if the doctor requires/OR my pet is a senior and I understand that this is a safety procedure required for senior patients.

NO, I will not accept the extra charge for a catheter and my pet is not a senior

Please check any additional services that you would like us to preform while your pet is anesthetized:

Nail Trim Microchip $20 Express Anal Glands

I have read and fully understand the terms and conditions set forth above.

Date Signed: December 3, 2023

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Audit

August 21, 2023 2:08 pm CST

Dental Consent Uploaded by Steve Garcia - steve@620studio.com IP 72.177.58.94