Procedure Consent Form

Patient Name*

First NameLast Name

Date*

Date of Procedure

Client Name*

Phone Number*

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

Pre-Anesthetic Bloodwork & Diagnostic Testing

Like you, our greatest concern is the well being of your pet. Before your pet is anesthetized, we perform a complete physical examination. Unfortunately, we are unable to detect many conditions that might affect your pet (disorders of the liver, kidneys, heart, or blood) with just a physical examination. To detect these types of problems, a blood test is performed. Blood tests to diagnose possible issues with your pet are especially important before any type of anesthetic procedure. Pharr Road Animal Hospital requires that every pet complete a blood screen (Complete Blood Count and Metabolic Profile) before every procedure that requires general anesthesia. Additional diagnostics, such as, but not limited to, abdominal x-rays, thoracic x-rays, abdominal ultrasound, urinalysis, echocardiogram, electrocardiogram, blood pressure screening, or additional bloodwork, may be required prior to general anesthesia based on your pet's individual medical need(s).

Pain Medication & Sedation

Like us, pets can feel pain before, during, and after dentistry and oral surgery. Unlike us, there is no way to explain to them what to expect. They are often unfamiliar with their surroundings, uncomfortable, and do not understand what they are experiencing or why. Our goal is to make your pet's anesthesia, dental and oral surgery experience as smooth, safe, and comfortable as possible. For this reason, Pharr Road Animal Hospital requires that every pet receive peri-operative pain medication(s) and sedation for anesthetic procedures. The veterinarians at Pharr Road Animal Hospital will carefully create an individual anesthesia and pain management plan that will focus on pain control and appropriate sedation before, during, and after the procedure(s).

Laser & Endoscopic Surgery and Diagnostics

Some procedures at Pharr Road Animal Hospital use a surgical laser. Some procedures use minimally invasive endoscopic techniques and equipment. Benefits from these include less pain, less bleeding, less trauma, decreased anesthesia time, and quicker recovery time.

DENTAL EXTRACTIONS: At Pharr Road Animal Hospital every dental patient undergoes a comprehensive oral health exam, assessment, and full, mouth dental x-rays, in addition to cleaning, scaling, and polishing all teeth. The veterinarians at Pharr Road Animal Hospital carefully examine your pet's mouth and teeth, and review their dental x-rays. Based on your pet's individual exam and x-ray findings, they may require dental extractions, oral surgery, or other medical recommendations.*

I DO NOT need a phone call to authorize any dental extractions deemed recommended by a veterinarianI WOULD LIKE a phone call prior to any extractions being preformed, and would like to be reached at my designated number above. If I am unable to be reached, I authorize all recommended extractions be preformed.If unable to contact me at my designated number, PLEASE DO NOT PERFORM ANY TREATMENTS.

CONSENT TO PROCEDURES INCLUDING ANESTHETIC RISKS

Dentistry, surgery, and diagnostic procedures are elective, invasive procedures and involve anesthesia. With all dentistry, surgery, and diagnostic procedures and with the use of anesthesia, risk is involved, including death. I understand the risk, give Pharr Road Animal Hospital permission to treat my pet, and know that every precautionary measure will be taken to ensure my pet's safety.

I acknowledge and understand that the procedure(s) detailed in the attached treatment plan provided by the veterinarians at Pharr Road Animal Hospital has (have) been described to me, and is (are) to be performed on the patient

Date

Client Signature