Dental Consent Form


    My pet is being admitted for a dental cleaning and/ or comprehensive oral health assessment under general anesthesia, and, in a few cases, for further treatment such as teeth removal. I understand that with dental disease, problems that are present may not be revealed until a thorough exam after cleaning under general anesthesia is performed. These dental procedures require general anesthesia and I understand and accept that there are always inherent risks, including death of the patient.

    The following options can help to reduce the risk associated with anesthesia and maximize patient safety. We highly recommend these measures for every patient having a surgical procedure.

    Pre-anesthetic blood screen: the risk of anesthetic complications is higher in animals with health problems. We recommend a pre-anesthetic blood screen for every patient having a surgical procedure. This checks for sub-clinical disease (hidden problems) not apparent on physical examination. On the basis of this blood work we can tailor your pet's anesthetic, pain management and recovery protocols to her/his individual needs. The fee for a pre-anesthetic blood screen is $120.00.

    Below, please decide whether you would like to authorize pre-anaesthetic blood screen or if you do don't authorize pre-anaesthetic blood screen and accept the inherent associated risks

  • Intravenous fluids (drip): intravenous (IV) fluids are very important for all procedures that require general anaesthesia. Administration of IV fluids helps your pet recover more quickly from anaesthesia, maintains blood pressure, and increases circulation during anaesthesia. It also allows rapid administration of drugs should an emergency arise and can save vital time in the rare event of an anaesthetic complication. To place an IV catheter and fluids it is necessary to clip or shave hair from the site (forearm or back legs). IV fluids are included with every dental procedure ($60 value).

    Below, I will confirm that I understand my pet may have one or more legs shaved in order to place IV fluids

  • Up to 30% of dental pathology occurs below the gum line and cannot be seen on gross examination. Dental radiographs (x-rays) are utilized to assess this potential pathology and our veterinarians highly recommend dental x-rays in order to better evaluate your pet’s oral health. In the majority of cases, radiographs can confirm the necessity for extraction of a tooth that may be loose, damaged or severely diseased. The fee for full mouth dental radiographs is $180.00.

    Below, I will confirm whether I authorize the attending doctor to proceed with dental radiographs. or whether I do not authorize any dental radiographs and understand that disease below the gum line involving the tooth roots and all surrounding tissues cannot be fully assessed without radiographs.

  • In cases where further work of a non-emergency nature (non-life threatening) is required such as teeth removal, selective dental x-rays, etc., every attempt will be made by the doctor to contact the owner to discuss the case. Please be aware that if you decline any needed procedures at this time, or, we are unable to reach you within 5 minutes, your pet would need a second anesthesia at another time in order for those procedures to be performed.

    I, the undersigned, owner or responsible party of the admitted patient, hereby authorize the doctors of Edmonton West Animal Hospital & Spay/Neuter Centre (and whomever they may designate as assistants) to administer further work up and treatments as necessary (once the case has been discussed with me, and verbal consent has been obtained) such as teeth removal.

    Further, I assume full financial responsibility for all charges incurred to this patient. However, I understand that if efforts to reach me are unsuccessful, and contact cannot be made at the phone numbers provided, no additional work will be performed and may have to be completed at a later date.

  • I understand that dental procedures, including simple and surgical tooth removal, can be associated with risks which may include broken tooth roots, bleeding, dry socket, inability of the pet to keep its tongue in the mouth, and damage to surrounding tissues. Rarely, fractures of the bone may occur, necessitating further work. At Edmonton West Animal Hospital, every effort is made to predict and avoid these complications but unforeseen events may occur. I understand these risks and acknowledge that they have been explained to my satisfaction.
  • Additional Procedures

    If you would like anything additional done at the time of the dental (e.g. lump removal, vaccination, tear duct flushing, etc), please describe in the box below. Additional cost estimates, where applicable, will be provided to you before these services are carried out, and are at the discretion of the attending veterinarian.

  • I hereby certify that I have read and fully understand the above authorization for dental and/or surgical treatment. Further, I acknowledge that any surgical/dental or post anesthetic complications may require additional veterinary care or medications which I assume full financial responsibility for. I also certify that no guarantee or assurance has been made regarding the results that may be obtained. I understand that the ultimate success of proposed dental treatment may depend on adequate home care and follow-up and acknowledge my responsibility in this regard, particularly for periodontal disease.
  • This field is for validation purposes and should be left unchanged.