CLIENT/PATIENT INFORMATION:

DENTAL RADIOGRAPHS:

It is often impossible to detect every possible dental issue your pet may have, until they are under anesthesia and their mouth is examined and x-rayed. Reasons for this are:

1. Lack of cooperation can impair visualization, especially of the back teeth.

2. Many Periodontal problems can be detected ONLY by probing under the gum or with dental radiographs (x-rays).

3. Dental tartar can hide underlying cavities or fractures.

With the information above in consideration, we ask that you tell us how you would like your pet's dental procedure handled today. 

Dental Radiographs:We can NOT fully evaluate your pets' dental health without full mouth radiographs!.

If problems are detected while your pet is under anesthesia, how should they be handled? Please choose 1 below.

ADDITIONAL SERVICES OFFERED:

Most services are less stressful and more comfortable under anesthesia.

ANESTHESIA SUPPORT SERVICES:

When general anesthesia is used for your pet's dental or other procedure, it is not without risk. To maximize their care and safety we may recommend your pet receive the supportive services below. Depending on your pet's age, some of these we may require. Complete descriptions of each are provided below. 

Keep in mind these services are at an additional cost, estimates are available upon request.

Please clearly accept or decline the following services. 

****SUPPORT SERVICES EXPLANATIONS:****

PRE-ANESTHETIC TESTING: To assess your pet's internal health before general anesthesia. Physical exams alone may not identify all of your pet’s health problems. Blood testing prior to anesthesia is highly recommended for all pets to help minimize the risks associated with anesthesia. It is important to understand that pre-anesthetic blood testing does not guarantee the absence of anesthetic complications or medical conditions that could require future treatment. The combination of tests we recommend for the apparently healthy pet are listed below. 

IV CATHETER/FLUIDS: Provides support for kidney function and instant intravenous access in case of an emergency. For any procedure in which anesthesia is used, an IV catheter is required for patients over 6 years of age. This allows us to provide fluids for support of kidney function and to have instant intravenous access in case of an emergency.  The time saved by placing a catheter before anesthesia could save your pet’s life.  Due to this reason IV catheters are recommended for ALL animals undergoing anesthetic procedures.

PAIN CONTROL: Injectable pain medication is administered to surgical patients to control pain immediately post – op.  Oral pain medications are available upon request. These medications will go home with your pet and provide lasting pain control.

EKG: Electrocardiogram (ECG, EKG) is an important test to give a quick but accurate assessment of your pet's heart health. Abnormalities in heart size and/or irregular rhythms can be diagnosed before they lead to a problem under anesthesia.

MICROCHIP IDENTIFICATION: During an anesthetic procedure is a great time to have your pet microchipped. Price includes the microchip, implantation, and 1^st year of enrollment with HomeAgain®. Without a microchip, 90% of lost pets do not return home.

PLEASE READ THIS SECTION CAREFULLY:

VACCINATION POLICY:  Our hospital recommends that your pet be current on their distemper and rabies vaccinations. WE require that in-patients be current on rabies. Proof that a rabies vaccine have been given by a veterinarian is required at admission.  If your pet is overdue for the rabies vaccine, it will be updated pending confirmation of a healthy animal.

FLEA POLICY:  Pets with fleas will be treated in the clinic at additional cost.

PAIN CONTROL: All patients undergoing a surgical procedure will receive pain medication, to be given at home, to ensure their comfort.

SURGICAL FOLLOW-UP POLICY: Surgeries that are not routine may require additional visits. There may be additional fees for these visits. We do not include these fees in the surgery cost since there may be more than one recheck.

CONSENT TO TREATMENT:

I am the owner or agent for the owner of the above-described animal and have the authority to execute this consent. I hereby authorize Heartland Veterinary Clinic to perform the procedure(s) listed above.  I understand that during the performance of the foregoing procedure(s), unseen conditions may be revealed that necessitate an extension of the foregoing procedure(s) that are set forth above. Therefore, I hereby consent to and authorize the performance of such procedure(s) as are necessary and desirable in the exercise of the veterinarian’s professional judgment.  I also understand that I will be responsible for full payment of services at the time my pet is discharged from the hospital.

I have read and understand this authorization and consent, and being of legal age (18), I hereby consent and authorize this hospital and its veterinarians and staff to perform the agreed to procedures.

• I have been advised as to the nature of the procedure(s) and/or surgery and the risks involved.
• I accept that anesthesia always involves some element of risk to my pet.
• I understand that every precaution is practiced to ensure the safety of my pet before, during, and after the procedure.

ESTIMATES AVAILABLE UPON REQUEST