Procedure Consent Form

I hereby certify that I have read and fully understand this authorization for treatment. I am the owner or agent for the above-described animal, am at least 18 years of age and have the authority to execute this consent.

If unforeseen conditions arise which, in the judgement of the attending veterinarian, call for procedures or treatments other than those now being authorized, I authorize such procedures if reasonable efforts to contact me for further consent are unsuccessful. I understand that I am responsible for the additional charges should additional procedures be required.

I understand some risks always exist with medication, procedures, anesthesia and/or surgery, and I am encouraged to discuss any concerns I have about those risks with my veterinarian before the procedure(s) is initiated. My signature on this consent form indicates that any questions have been answered to my satisfaction. No warranty or guarantee has been given to me as to the results or cure afforded by these treatments or procedures.

I HAVE READ AND FULLY UNDERSTAND THIS CONSENT FORM. I have had the fees outlined to me and agree to pay all such fees and charges at the time of discharge.

I hereby grant Ilderton Pet Hospital, its employees, or agents permission to take photographs, and/or videos of my pet, and to identify my pet by name. I authorize the Hospital to copyright, use and publish those photographs or videos for any lawful purpose, including, but not limited to, their website, social media accounts, and promotional materials, either digital or in print, in perpetuity.

I have not given my pet any food after 10 PM on the night before the procedure and no water after 6 AM on the morning of the procedure. I understand this is important for safety.

I will inform the admitting staff member of any new changes or concerns with my pet's health when dropping them off for the procedure. If any health concerns arise prior to the procedure, I will contact the Hospital and inform a staff member.

Many oral health issues can not be detected until a thorough dental exam is performed under anesthetic. I understand that there may be additional extractions or dental procedures required that were not initially noted during the clinical exam. Complications of dentistry are rare but can include hemorrhage, nerve injury, destabilization or fracture of the jaw, retained root material, loss of teeth adjacent to the extraction and infection.

In some cases, the baby teeth do not fall out and both the adult and baby tooth are contained in one socket. These are called persistent deciduous teeth and can pose a problem for long-term dental health if they are not addressed.

The day before the procedure, one of our technicians will be reaching out to review the estimate, confirm a drop-off time, and answer any questions you may have. This phone call typically takes place in the afternoon. 

If you have any questions or concerns you would like addressed prior to this phone call, please do not hesitate to reach out via phone or email. 

We look forward to seeing you and your pet soon!

Sincerely, 

The Veterinarians & Staff of Ilderton Pet Hospital