Dental Surgery/Sedation Authorization Form

Pre-Anesthetic Risk - Diagnostic Testing - elective surgeries

Your animal is scheduled for a diagnostic or surgical procedure requiring a general anesthetic or a significant level of sedation. The Animal Care Center (ACC) recommends a blood profile and/or other diagnostic testing to ensure that your pet can be maintained in as low risk category as possible both before and during the procedure. Improving technology now allows the (ACC) to screen for more subtle and sub-clinical internal changes that may complicate induction and maintenance of anesthesia. In elective surgeries, abnormal values may warrant additional testing and delaying a surgical procedure until the underlying issues can be identified, compensated for or corrected. Additionally, the result of any testing can be a valuable asset to the health care database of your animal in the event of an illness later in life. The ACC staff are committed to achieving 100% success in every anesthetic or surgical procedure performed; however, no outcome can be guaranteed 100%.

The Basic Dental Cleaning Package offered by Animal Care Center (ACC) includes: preoperative sedation, an intravenous catheter for fluid and blood pressure support, anti-nausea medications, hospital day admittance, anesthesia induction, maintenance and monitoring, and a complete dental prophy including a thorough oral exam, ultrasonic tooth cleaning, scaling, polishing, and Oravet sealant application.

Basic Dental Package Cost: Canine package: $529.00 Feline package: $499.00

Our complete oral exam may identify more than just "dirty" teeth, begins after anesthesia, and may find:

• Heavy to severe calculus accumulation causing gingivitis (redness and/or bleeding of gums), progressing to deep pockets and bone recessions. This leads to loose teeth for which extraction is the recommended procedure.
• Fractures of the tooth caused by trauma or chewing on hard items such as rocks, fences or bones. If the fracture has exposed thepulp canal, abscessing of the tooth is an imminent risk due to the open pulp cavity to the root tip. A root canal (by a specialist) or extraction may be recommended.
• Resorptive lesions are very common in cats, but also identifies in dogs. It is a condition where a hole develops in the tooth's crown, usually at or below the gum line. It can progress to the point of crown loss. The cause is unknown and since it is an extremely painful condition, extraction of the affected tooth is the only recommended treatment.
• Epulis or other oral tumors may be found - excision or biopsy may be recommended.
• Dental radiographs as required by law for extraction will be taken to determine the course of treatment. 

Additional Dental Estimates

• Dental X-rays: $24.00 each x-ray or $174.00 for full mouth
• Nerve Blocks: $18.00
• Extractions may vary with difficulty: $30.00 per 15 min block of time
• Oral Surgery: $30.00 per 15 min block of time
• Additional anesthesia time: $34.00 per 15 min block of time
• Additional medications to go home: $15.00 - $ 35.00
• Laser pain management: $25.00

 

Permission to Perform Surgery or Other Invasive Procedure

I am the owner or the agent for the owner of the animal described above, and I have the authority to execute this consent. I hereby consent and authorize the Animal Care Center to receive, prescribe for, treat for, or operate on my pet, and I fully understand that there may be risks associated with the procedure(s) and/ or anesthesia. Possible complications of surgery include bleeding and infection, damage to other internal organs, blood clots, allergic or other bad reactions to one or more of the substances including anesthetic agents used in this surgery, and death of your animal. I further understand that during the course of the operation or procedure, unforeseen conditions may arise that may necessitate the performance of additional procedures. I agree to pay, in full, for services rendered, including those deemed necessary for medical or surgical complications or otherwise unforeseen circumstances. Any estimate or charges for the presently planned procedure are only a best approximation. This is only an estimate, final charges can only be calculated at the end of treatment. I have read the foregoing statements and agree to these terms.

Permission to Perform Anesthesia and Prophylaxis Dentistry

As the owner or owner's agent of the animal described above, I hereby consent and authorize the ACC doctors and/or licensed technicians to receive, prescribe for, treat for, or operate on my pet, fully understanding that there may be risks associated with the procedure(s) and/or anesthesia. Possible complications include bleeding and infection, damage to other internal organs, blood clots, allergic or other bad reactions to one or more of the substances including anesthetic agents used in surgery, and death of our animal.I further understand that during the course of the procedure, unforeseen conditions may arise that may necessitate the performance of additional procedures. I agree to pay in full, for the services rendered, including those deemed necessary for medical or surgical complications or otherwise unforeseen circumstances. Any estimate or charges for the presently planned procedure are only a best approximation. This is only an estimate, final charges will be calculated at the end of treatment.