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Dublin Animal Hospital 888 Dublin Blvd. Colorado Springs, CO 80918 719-593-1336 Fax: 598-4141
Owner: Pet’s Name: File#: DAH use Phone Numbers Today : __________________ Contact Instructions: __________ Home: __________________ Work: __________________ Cell:
DENTAL PROCEDURE CONSENT FORM: Regular pet dentistry is an extremely important component in ensuring that your pet is able to live a fuller, healthier and happier life. Dental x-rays are a valuable tool that allow us to evaluate the health of your pets teeth. YES, I give permission to have my pets teeth x-rayed, (if needed). NO, I decline x-rays of my pets teeth taken. -Some times, the extraction of teeth is the best course of action.- YES, I give permission for extraction(s), if deemed necessary by the attending veterinarian. NO, I delcine extractions.
CONSENT FOR PRE-ANESTHETIC BLOOD TESTING: Like you, our greatest concern is for the well-being of your pet. Before putting your pet under anesthesia, we will perform a full physical examination. However, many conditions, including disorders of the liver, kidneys or blood, are not detected unless blood testing is performed. Such tests are especially important before any kind of surgery. For these reasons, we highly recommend blood screening before such procedures. Our laboratory is fully equipped and staffed to perform these important blood tests. Results will be immediately available to examine before anesthesia and/or surgery. Please indicate your choice below: YES, I want my pet to have a pre-anesthesia blood screen. NO, I do not want my pet to have a pre-anesthesia blood screen.
CONSENT for IV FLUIDS DURING DENTISTRY: In the aging process, the ability for the kidneys to perform their necessary functions gradually declines. IV fluids during anesthetized procedures increases blood flow to the kidneys and helps support their functions. This improves your pet’s tolerance of the anesthetic agents and the procedures performed. The Please indicate your choice below: YES, I want my pet to receive IV fluids during surgery or dentistry. NO, I do not want my pet to receive IV fluids during surgery or dentistry.
I understand that all medical and surgical procedures carry an inherent risk. In signing this document, I acknowledge, understand and accept these risks and will not hold the Dublin Animal Hospital, its affiliated veterinarians, or staff, liable for damages resulting from these procedures. I understand and acknowledge that this animal must be current on all vaccinations or that it must be brought up to date on all vaccines before the scheduled surgery. Unless otherwise instructed by the attending veterinarian, all animals left at the hospital longer than five (5) days will be considered abandoned, and ownership may be transferred or the animal may be destroyed. By signing this document, I understand and acknowledge I am liable and responsible to pay for all the costs of the services rendered. These costs may include boarding, hospitalization and other related costs that may be incurred beyond the originally defined procedures. I have read, understand, and agree to the terms of this document. I hereby certify that I am over 18 years of age. I also certify that I have the legal authority to make decisions concerning this animal and am in a position to be bound legally under applicable
(Owner/Agent)Signed:____________________________________Date: Dental X-Rays, Extractions, Pre-Anesthetic Blood Screening and IV Fluids are additional costs to the dental procedure itself. Please call 719-593-1336 for pricing information. |
