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  • Dental Cleaning Release Form

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  • Procedural Information:

    • Anesthesia: Pre-surgical blood tests and a physical exam will enable us to assess and minimize risk of anesthesia to your pet. 
    • Monitoring: To minimize anesthesia risk, we monitor the heart rate, blood pressure, respiration rates, temperature, and oxygenation.
    • Pain Management may be necessary in some dental procedures. The doctor will administer pain medications according to your pet's need, which can be an additional fee ranging from $15-40. 
    • Antibiotics may also be necessary and will be prescribed by the doctor according to your pet's need for an additional fee ranging from $10-60.
    •  An Intravenous Catheter is also required for all patients. For sterility, hair will be shaved over a vein on the leg so that the intravenous (I.V.) catheter can be placed. Blood pressure may lower during anesthetic procedures and fluid therapy aids in supporting your pet's internal organ systems before, during, and after surgery. It also allows immediate access to the vascular system in case of an emergency. This procedure is highly recommended, especially for those with known medical conditions or advanced in age. 
  • Anesthetic Screening Consent

    Like you, our greatest concern is the wellbeing of your pet. A physical exam will be performed before sedating your pet. Howevery, many conditions, including disorders of the kidneys, liver, heart, and blood cannot be detected without blood lab screening and heart electrocardiograms. For these reasons, we require pre-operative blood screening before sedating your pet for teeth cleaning. If you have more questions about this screening, please talk to the staff the day of surgery. 


  • Patient Information Section

  • Extractions:

    It can be difficult to predict if teeth need extraction when an animal is awake because tartar and movement interfere with the assessment. Severely diseased teeth can cause considerable pain and discomfort and are a source of infection for other organ systems (liver, kidney, lungs, heart, etc.). During the dental cleaning, the teeth are evaluated and if found to be diseased they may required extraction or referral to a dental specialist for repair. The cost of extraction varies depending on the amount of time taken and the difficulty of removal and can range from $12 to $45 per tooth. 

  • Authorization:

    I HAVE READ AND FULLY UNDERSTAND THIS ANESTHESIA AND SURGERY CONSENT FORM. I authorize anesthesia and surgery for my pet, as described above. The nature and risks of this procedure have been explained to me. I understand that some risks always exist with anesthesia, surgery, and dentistry, and I am encouraged to discuss any conserns I have about those risks with the hospital's medical staff before the procedure(s) is/are initiated. Additionally, I authorize Family Pets Veterinary Care to perform any diagnostic, medical treatment, surgical procedure, or dentistry as deemed necessary for any unforeseen medical or surgical complications if one should arise. While Family Pets provides the highest quality of anesthesia monitoring, surgical services, and dentistry, I completely understand the possibility of unforeseen complications that may occur during any associated anesthetic, surgical procedure, or dentistry. I fully acknowledge and understand these medical risks. I recognize that the veterinarian and clinic staff will do all that is necessary to minimize such risks. I will hold harmless Family Pets Veterinary Care, the veterinarian, or any clinic staff member liable for any complications that may or should arise in my pet's medical treatment and care. I understand that the clinic is not liable for any lost or damaged personal property (leashes, collars, etc) that are left in the clinic. No warranty or guarantee has been offered or given to me as to the results or cure afforded by these treatments or procedures.  

     

    Signed,

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