top of page
  • Facebook
  • Instagram
  • TikTok

Dental Consent Form

Date
Month
Day
Year

It is our hospital policy that all dogs and cats be current on rabies vaccination.  Please provide prior vaccine records if available. Patients without proof of current rabies vaccination may be vaccinated during their visit at the owner’s expense at the veterinarian’s discretion.


Patients presented with live fleas or ticks may receive treatment at the owner’s expense to reduce transmission risk within the hospital.


ANESTHETIC/SURGICAL CONSENT:I authorize the use of appropriate anesthetics, sedatives, and medications deemed necessary for my pet’s treatment and care. I further understand that there are certain risks involved with all types of anesthesia and procedures.  I acknowledge that no guarantee has been made as to the results that may be obtained.


I assume full financial responsibility for all charges incurred relating to my pet’s treatment and care and understand that payment in full is due at the time my pet is discharged.


I understand unforeseen conditions may be discovered during anesthesia, sedation, surgery, dental procedures, or hospitalization. I authorize NHVGS veterinarians to provide additional diagnostics and treatment considered medically necessary for the health, comfort, or stabilization of my pet while reasonable attempts are made to contact

I request the following additonal services be performed:

DENTAL EXTRACTION CONSENT

I understand that the full extent of dental disease often cannot be determined until my pet is anesthetized, a full oral examination is performed, and dental radiographs are obtained. We understand concerns about extractions and the possibility of losing teeth, however, our goal with dentistry is to address the dental disease currently present and provide a pain-free mouth, and to develop a preventative care plan going forward.


I understand that some teeth may appear normal externally but may require extraction due to underlying disease identified during the procedure.


I understand that dental cleaning alone does not treat diseased teeth requiring extraction

In the event that your pet requires extraction(s), do you give permission to NHV – Gwinn Sawyer to proceed as needed to provide your pet a pain-free and healthier mouth?
If we cannot reach you for some reason, do you give NHVGS to proceed as recommended?

If you elect NO, please understand your pet will receive the scheduled dental cleaning procedure and no extractions or further treatment. A future surgery will need to be scheduled at a later date, at additional cost, to complete the procedure.

CPR CONSENT:

I understand that anesthesia and sedation carry inherent risks, including complications, cardiac arrest, and death, despite appropriate monitoring and care.


I understand that CPR success rates in veterinary patients are variable and may be low depending on my pet’s condition.


CPR efforts may include chest compressions, intubation, oxygen support, emergency medications, emergency procedures, and/or continued hospitalization, which may result in additional costs.

In the absence of a signed CPR decline, NHVGS staff may initiate CPR at the attending veterinarian’s discretion

CPR Acknowledgement
Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.
  • Facebook
  • Instagram
  • TikTok
bottom of page