Dental Consent Form (02) 9388 2551 Book Online Please fill out the Dental Consent Form prior to your pet’s visit with us. Dental Consent Form Client Name: * Contact Number: * Email: * Patient Name: * Sex: * Breed: * Age: * Procedure: * Has your pet ever had an allergic reaction to any medications? * Yes No I understand my pet needs to be fasted 10 hours prior to the procedure. * Yes No Has your pet been unwell in the past 48 hours? * Yes No Is your pet on any medications? * Yes No Medication name, dose & time given: I consent to the administration of a sedative and/or anaesthetic to the above animal. * Yes No All patients undergo pre anaesthetic blood testing to detect major organ abnormalities that may complicate the anaesthetic and identify any underlying medical conditions that require treatment. The results also form a good baseline measure of your pet's health. If you do not wish to have pre anaesthetic blood test prior the procedure, please opt out here: Opt Out During your pets dental the vet will probe and map all teeth. This enables the vet to identify which teeth may needextracting, which teeth are at risk and which teeth are healthy. In the event your pet requires extractions; Do you consent to the extraction of a tooth / teeth if necessary? * Yes No Dental X-rays: As with human dentistry, X-rays are used as a diagnostic tool. These detailed images allow the vet to assess the roots of the teeth and treat dental disease below the gum line. Many animals can have abnormal teeth that appear normal on a standard dental examination. We recommend full mouth dental radiographs for all our patients Studies show that without dental radiographs 30% of abnormalities can be missed in dogs, and 50% in cats. If you do not wish to have full mouth x-rays, please opt out here: Opt Out If the vet recommends any additional extractions other than what was estimated we will contact you. If we cannot reach you on the above contact number we will proceed in the best interest of your pet. I understand the cost of treatments involved and undertake to pay this on collection of my pet. In the event of circumstances arising requiring further treatment or surgery, I give authorisation to such procedures deemed necessary in the opinion of the veterinary surgeon and understand that these may incur extra costs. I understand and accept that all treatments, anaesthetics and surgical techniques involve risk to the animal, including risk of death and I accept such risk, given all reasonable skill and care is taken by the veterinary surgeon and support staff. Signature signature keyboard Clear (Owner/Authorised Agent) Date Captcha Submit If you are human, leave this field blank. (02) 9388 2551 Book Online