Authorization forDental Procedure with Anesthesia Form

Make the most of your next appointment by saving time! Before your appointment, fill out your authorization for dental procedure with anesthesia form from any device at any time.

Authorization for Dental Procedure with Anesthesia Form

Pet Information

Contact Information

Note: In case of an emergency and/or prior to additional procedures, you will be contacted by telephone. Please keep yourphone with you.

In addition to the planned procedure and pre-operative diagnostics, we offer the following options added to your pet’s plan to help ensure safety and comfort (see additional cost).

Dental Procedure Information

It is the recommended standard of care in Veterinary Dentistry that x-rays be taken during dental cleaning procedures. Veterinary Dental Specialists recommend that x-rays be taken of every tooth during every procedure. Studies have shown that 70% of cats and 80% of dogshave some degree of periodontal disease by 2 years of age (varying from inflammation of the gums to loose teeth, gum recession, and infection at the roots of teeth), and up to 40% of cats studied have tooth resorption (tooth resorption results in a hole in the tooth, exposing the nerve and causing pain). Dental x-rays help us find these problems. Often disease conditions will be found that cannot be readily seen without the x-rays. We include dental radiographs on all treatment plans when indicated. A Dental Prophylaxis (dental cleaning) involves ultrasonic scaling of all tooth surfaces including subgingival cleaning where needed. Polishing and application of fluoride is performed after cleaning. After the Dental Prophylaxis, a complete examination of the mouth is performed by the Doctor. During examination the Doctor may find that one or more teeth need to be extracted. This may be due to advanced periodontal disease, fractures of the tooth, resorptive lesions, caries, etc. Extraction of teeth often includes the administration of intraoral nerve blocks. We recommend that you leave the decision to extract teeth up to the Doctor's discretion. But, if you feel that you would rather be informed prior to any extractions we will be happy to contact you. But, PLEASE make sure that you are available at the contact number that you leave with us today. We do not want your pet to be under anesthesia any longer than is necessary.

Please acknowledge the following surgical/anesthesia Information:

We place the highest priority on ensuring you feel comfortable with the plan for your pet’s care and fully understand the authorizations above before giving your consent. If you have any questions or need clarification on any of the choices, please contact the hospital so a medical team member can review the form with you prior to completing it. As always, thank you for entrusting us with your pet’s care!
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