Dental Procedure Authorization Form

Dental Procedure Authorization Form

Provide your pet and contact details, review sedation and dental risks, and authorize the veterinarian to perform the planned dental procedure.
Owner Information
Owner Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Pet Name
Age
Species
Breed
I confirm that my pet has been fasted as instructed prior to today's procedure.
Procedure Authorization and Sedation Consent
Acknowledgement

I authorize Precision Veterinary Services and Dr. Michael Orban to perform a professional dental procedure on my pet.

The dental procedure includes a comprehensive oral examination, ultrasonic scaling, professional polishing and an oral health assessment. The purpose of this procedure is to remove plaque and tartar, evaluate oral health, and help maintain healthy teeth and gums.

Dental procedures are performed using twilight anesthesia rather than full general anesthesia. Twilight anesthesia provides a carefully monitored level of sedation that allows your pet to remain relaxed and comfortable while maintaining many normal protective reflexes. This approach generally requires less anesthetic medication than general anesthesia and is associated with a smoother recovery for many patients. During the procedure, your pet's heart rate, respiratory rate, oxygenation, temperature, and overall condition will be continuously monitored.

Although every precaution is taken to minimize risk, all sedation and anesthesia carry inherent risks, including but not limited to: adverse drug reactions, low blood pressure, cardiac or respiratory complications, aspiration, delayed recovery and death (rare).

I understand these risks and authorize sedation as deemed appropriate by the veterinarian. I understand that: No veterinary procedure is without risk. The practice of veterinary medicine is not an exact science, and no guarantees regarding outcome or cure have been made. Every reasonable precaution will be taken to ensure my pet's safety and comfort.
Dental Findings

I understand that a complete oral examination cannot be performed until my pet is sedated and the teeth have been professionally cleaned. If additional treatment is recommended, including: tooth extractions, dental radiographs (if indicated), treatment of fractured or diseased teeth or other oral surgical procedures, these procedures will NOT be performed during today's appointment.

The veterinarian will discuss all findings with me following the procedure and provide recommendations and a detailed estimate for any additional treatment that may be necessary.

I authorize Precision Veterinary Services to perform today's dental procedure.
Authorization for Dental Procedure and Sedation Consent
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Dental Procedure Authorization Form

Owner Information

Procedure Authorization and Sedation Consent