DENTAL CONSENT FORM

This form is to promote a clearer understanding of the process involved in cleaning your pet’s teeth. Please be aware of the following facts:
1. A thorough evaluation of your pet’s mouth, teeth and gums cannot be accomplished without the aid of a general anesthetic.
2. Incidental findings, such as tumors and abscessed tooth roots, periodontal (gum) disease, cracked teeth, or Feline Odontoclastic Resorptive Lesions ( a progressive, cavity-like disease in cats) are NOT uncommon.
3. It is frequently necessary to change our treatment plan once the pet is anesthetized.
4. Decisions about how to treat particular problems are highly dependent on your dedication to follow up care, potential cost involved, anesthetics and relative anesthetic risk.
5. Certain specialized procedures i.e. crowns and root canals, are not provided at our facility, but are available through a veterinarian that specializes in dentistry and the cost for these procedures have been compared to the cost that people pay for like procedures. We can refer you to a specialist if you so desire.
6. Certain disease processes are progressive and it is our intent to minimize pain. Therefore, we may elect to perform procedures that will avoid unnecessary pain for your pet in the future. (i.e. we may extract a tooth that is not yet loose, but has significant bone loss around it.)
7. The removal of some teeth may result in unavoidable consequences, such as the inability of your pet to keep its tongue in its mouth (common with canine or ‘fang’ extractions) or even jaw fracture (very rare event but a risk factor).
In order to minimize the time in which your pet spends under anesthesia it is important that we know your desires before proceeding. This avoids delays due to the time taken to contact you or worse yet, not being able to contact you at all during the procedure, and during a time in which a crucial decision needs be made. In most cases we make decisions as if we were treating our own pets.

If you have any questions about the general anticipation and the degree of dental/oral work that is to be completed feel free to ask the doctor prior to your pet’s procedure.
Please check the appropriate box or boxes below:

By checking one of the following I understand that, in the event I cannot be contacted, my pet may require an additional procedure at a future date, which may involve an anesthetic procedure and could result in substantial additional cost.
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- Please complete any and all procedures that are deemed necessary to treat current problems, minimize pain my pet may experience in the future from ongoing dental disease and or any other abnormalities discovered in the mouth or throat. I also acknowledge that I am aware that this may involve the extraction of teeth, oral surgery, radiographs, biopsy samples and or other lab work. All of which may have additional charges over and above any estimates given prior.
- Please do any and all procedures deemed necessary, but do not exceed the estimated amount unless otherwise agreed.
- Please do NOT, under any circumstances proceed with anything more than a routine cleaning without contacting me.
- Please do NOT extract any marginal teeth that may require extracting in the near future. I am aware that this will require significant follow up care to prevent rapid progression of disease and possibly increased pain until any additional procedures are performed.
- I would be interested in pursuing specialized care, even if this means leaving currently diseased and potentially painful teeth in the mouth of my pet until I can get an appointment with a specialist.
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