Dental Consent Form Westlake

Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Secondary Phone

Please enter a valid phone number.Format: (000) 000-0000.

Is it okay to text this phone number with updates or reminders?

Animal Name

Animal Species

Animal Breed

Animal Age

Animal Sex

Animal Weight

What procedure will your pet be having?

Has your pet been fasted past 10pm as instructed?

Is your pet eating and drinking normally?

Please explain

Has your pet experienced any of the following?

Please explain

Have you noticed any changes in your pets energy level or attitude?

Please explain

Is your pet currently on any medications?

Please list each one your pet is currently on, as well as date last given, dosage amount, and when the next dose is due

If your pet is due for vaccinations, would you like them administered at the time of surgery?

Would you like us to administer them today?

Dental Procedures:

Dental Cleaning is the procedure to remove alculus (hardened tartar) from the crown of the tooth as well as under the gumline using an ultrasonic scaler. Once the teeth are cleaned, they are polished to ensure they are smooth.

Dental Radiographs are necessary to identify and diagnose dental disease under the gumline. These are performed during every dental cleaning.
Doxirobe Gel is an antibiotic that in some cases can be placed under the gum line of a tooth with a periodontal pocket in an effort to preserve the life of the tooth.
Composite Sealants can protect chipped or fractured teeth from sensitivity if the nerve is not exposed. In most cases if the pet needs a composite sealant we can do this at the time of the dental cleaning. If the nerve is exposed, we will recommend extracting that tooth as it is very painful for the pet.
Extractions are performed when the veterinarian has determined that a tooth is severely diseased and/or broken and needs to be removed for the health and safety of the pet. We make every effort to save a tooth if it viable and only recommend extractions when they are medically necessary.

We often identify dental problems after our patients are anesthetized that we were unable to identify while they were awake during a previous exam. While we do save all viable teeth, sometimes composite sealants, doxirobe gel, or extractions are necessary. It is imperative that we have a number where we can contact you at anytime during the procedure.

If we are unable to contact you with an updated treatment plan please select one of the following:

Would you like to sign up for a courtesy nail trim?

Would you like a microchip placed during the procedure?

Please list any personal belongings coming into the clinic (please note that we do not recommend any belongings come into the clinic with your pet including bedding, collars, leashes and harnesses as we cannot guarantee it will be returned).

Please check each box to acknowledge each statement below:

The best telephone number to reach out regarding my pets care today is

Please enter a valid phone number.Format: (000) 000-0000.

I authorize Westlake Animal Hospital to photograph and post photos of my pet(s) on social media.

The vast majority of procedures and hospitalizations have good outcomes and proceed according to plan. In the unexpected event of a sudden decline of your pet’s health, we want to be prepared to respond in a manner that meets your wishes and fulfills your emotional and financial needs.

Signature

Dental Consent Form

Client Details

Animal Details

General Health Screening