Dental Permission Form in Virginia Beach, VA

I authorize Abbey Animal Hospital to receive and provide care for my pet. I understand that all precautions will be taken to ensure the safety and health of my pet during his/her stay. I also understand that every attempt will be made by doctors and staff to notify me prior to additional medical treatments or cost. If however, I cannot be reached, I authorize Abbey Animal Hospital to perform the necessary lifesaving procedures for my pet at our discretion. I assume full responsibility for all medical expenses incurred during my pet’s stay.

To prevent the spread of infectious disease and parasites, all animals must be current on all vaccines and free from internal and external parasites. I have either provided current records or I authorize Abbey Animal Hospital to vaccinate and treat for internal and/or external parasites, as is necessary.

I understand that all anesthesia involves some risk to my pet including (very rarely) death and unforeseen complications such as infection, bleeding with certain dental procedures. I am aware that many pre-existing conditions can be identified prior to the dental by performing in house blood diagnostics.

Required for Pets Over 7 Years of Age

OPTIONAL FOR ROUTINE PROCEDURES ON PATIENTS UNDER 7 YEARS OF AGE, BUT STILL RECOMMENDED

Blood Work

PREOP Blood work
I DECLINE the preop bloodwork and my pet is under 7 years of age, and understand the risks involved in not having it done.

Dental Sealant

SANOS Veterinary Dental Sealant is a one-step application by the veterinarian that seals the subgingival gumline against the formation of plaque. One application lasts up to 6 months. There is an additional charge.*

Yes, please apply SANOS dental sealant
I DECLINE the SANOS dental sealant

Extractions

During the course of the examination and cleaning, loose or decayed teeth may be found. Unhealthy and decaying teeth can lead to further health complications for your pet including, but not limited to heart disease. If, in the doctor’s professional judgment, these teeth should be removed:*

Yes, I give my consent for the doctors to use their professional judgment and extract any teeth necessary to maintain my pet’s health. I also understand that more complicated surgical extractions are generally not done during a routine cleaning to reduce prolonged time under anesthesia.
Yes, I give my consent for extractions AFTER I have been called and informed of the situation. If I am NOT available, then I DO give my consent for the doctors to extract any teeth necessary, up to [amount specified]. I also understand that more complicated surgical extractions are generally not done during a routine cleaning to reduce prolonged time under anesthesia.
Contact me prior to extracting any teeth. If I am NOT available, then I DO NOT consent for the doctors to extract any teeth. I am aware that the doctors believe teeth may need to be removed and that my pet may have to undergo additional anesthesia in the future to have these teeth removed. If this box is initialed, then no teeth will be removed without verbal authorization from the owner.

Max Amount*

Bitewing X-Rays

Bitewing x-rays allow the veterinarian to look at the tooth below the gum line, and often assess issues we are unable to detect visually during a professional dental cleaning. They are highly recommended.*

Yes, please take bitewing x-rays
I DECLINE the bitewing x-rays

Don't Waste the Anasthesia!

Your pet will be going under general anesthesia, which affords an opportunity to perform procedures that may be more difficult when your pet is awake. Anesthesia is much safer now than in years past, so we recommend making the most of this event. Please check any and all of the following procedures you would like performed while pet is under anesthesia.

*Toenails can be trimmed much closer. Long toenails can be painful and contribute to lameness. They can become broken and infected if not trimmed regularly. In some cases a laser nail trim may be preferred, at an additional charge.
Ears can be flushed. Ear infections are common, and if not attended to, can be very uncomfortable and lead to serious ear conditions and/or surgery.
Sanitary grooming can be performed at this time. This may not be easily done in an awake animal but can be easily performed under anesthesia. Fecal matter and Urine can cling to the fur (especially long hair) and can be breeding grounds for bacteria and fungal infections not to mention maggots in warm weather. A full grooming is not recommended at this time due to any potential complications
X-rays (i.e. those hips, elbow, and stifle radiographs), blood, stool, urine, and other samples can be easily acquired at this time. This is a great time to collect samples as long as the regular blood work is OK for anesthesia.
*A Microchip can easily be placed to help you find your lost pet. Nail trim & microchip charges are discounted when done while pet is under sedation.

I have read all the above information and I understand and accept all the risk and responsibility involved. I also understand that unforeseen complications may occur which may incur additional charges.

Signature

(must be 18 years of age or older)

Date

Contact Number*

2nd Contact Number