• Dentistry Consent Form

    Companion Animal Clinic
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  • This form is intended to promote a clearer understanding of the process involved in cleaning your pet's teeth. Please be aware of the following facts:

    * A thorough evaluation of your pet's mouth, teeth, and gums cannot be accomplished without the aid of a general anesthetic. Therefore we may not be able to know in advance how many teeth may need to be extracted or how long the cleaning itself may take.

    * Incidental findings, such as tumors, abscessed tooth roots, periodontal (gum) disease, cracked teeth, or Feline Odontoclastic Resorptive Lesions (a progressive, cavity-like disease in cats) are not uncommon.

    * It is frequently necessary to change our treatment plan once the pet is anesthetized and a complete oral examination has been performed.

    * Decisions about how to treat a particular problem are highly dependent on your dedication to follow up care, potential costs involved, aesthetics, and relative anesthetic risk.

    * Certain specialized procedures (i.e. crowns and root canals) are not provided at our hospital, but are available through veterinarians that specialize in dentistry. These procedures are usually comparable, or more expensive than the same procedures in people. We can refer you to a veterinary dental specialist for follow up care, if you so desire.

    * Certain disease processes are progressive and it is our intent to minimize pain. Therefore, we may elect to perform procedures that will avoid unnecessary pain in the future. (i.e. we may extract a tooth that is not yet loose, but has significant bone loss around it.)

    * The removal of some teeth may result in unavoidable consequences, such as jaw fractures, or an inability of the pet to keep its tongue in the mouth.


    In order to minimize the time that your pet spends under anesthesia, it is important that we know your desires before proceeding. This avoids delays involved with us trying to contact you to discuss your wishes; or worse yet…..us being unable to contact you at all at a crucial decision making point. In most cases, we make decisions based upon our values as if we were treating our own pets.

    If you have any questions about the general anticipated degree of dental/oral work anticipated on your pet, please feel free to ask prior to your pet being admitted to the hospital for his/her procedure.

  • Though complications are rare, there is inherent risk in surgery and general anesthesia. Companion Animal Clinic cannot be held responsible for any reactions your pet may have to these medications. By signing below you are giving consent to the staff and veterinarians of Companion Animal Clinic to anesthetize and perform the previously listed procedures (unless specifically declined) and acknowledge that you understand the special notes explained. By signing below you also agree to indemnify and hold the staff and veterinarians of Companion Animal Clinic free from and against any and all liability that may arise out of the performance of any of the procedures referred to above.

    We will make every effort to reach you should questions or problems arise, however, by signing this form you authorize the doctor to treat your pet as deemed necessary should he/she be unable to contact you at the number(s) provided.

    By signing below you certify that you are the owner or authorized agent for the above named animal and that you are responsible for him/her and have the authority to execute this consent.

    By signing below you agree that you are responsible for payment in full of all above mentioned procedures and treatments at the time the patient is discharged.

    I have read and understand ALL of the above information.

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