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  • Dental Prophylaxis/Surgery and Treatment Consent

  • CLIENT/PATIENT INFORMATION:

  • HOSPITAL AND PROCEDURAL INFORMATION: 

    DENTAL PROPHYLAXIS INCLUDES:

    • Oral exam, probing and charting of each tooth
    • Scaling and polishing of teeth
    • *** Extractions as/if needed

    VACCINATION POLICY:  Our hospital recommends that your pet be current on their distemper and rabies vaccinations. WE require that in-patients be current on rabies. Proof that a rabies vaccine have been given by a veterinarian is required at admission.  If your pet is overdue for the rabies vaccine, it will be updated pending confirmation of a healthy animal.

    FLEA POLICY:  Pets with fleas will be treated in the clinic at additional cost.

    PAIN CONTROL: All patients undergoing a surgical procedure will receive pain medication, to be given at home, to ensure their comfort.

    SURGICAL FOLLOW-UP POLICY: Surgeries that are not routine may require additional visits. There may be additional fees for these visits. We do not include these fees in the surgery cost since there may be more than one recheck.

  • DENTAL PROCEDURE:

    All patients will have full mouth radiographs evaluated during the procedure. It is often impossible to detect every possible dental issue your pet may have, until they are under anesthesia and their mouth is examined and x-rayed. Reasons for this are:

    o        Lack of cooperation can impair visualization, especially of the back teeth.

    o        Many periodontal problems can be detected only by probing under the gum or with dental radiographs (x-rays).

    o        Dental tartar can hide underlying cavities or fractures.

  • *** If problems are detected while your pet is under anesthesia, how should they be handled? Please choose 1 below.

  • ANESTHESIA SUPPORT SERVICES:

    When general anesthesia is used for your pet's dental or other procedure, it is not without risk. To maximize their care and safety, in addition to your pet’s dental prophylaxis, we may recommend your pet receive the supportive services below. Depending on your pet's age, some of these we may require. Complete descriptions of each are provided below. 

    Keep in mind these services are at an additional cost, estimates are available upon request.

  • ADDITIONAL SERVICES OFFERED:

    Most services are less stressful and more comfortable under anesthesia.

  • I am the owner or agent for the owner of the above-described animal and have the authority to execute this consent. I hereby authorize Heartland Veterinary Clinic to perform the procedure(s) listed above. I understand that during the performance of the foregoing procedure(s), unseen conditions may be revealed
    that necessitate an extension of the foregoing procedure(s) that are set forth above. Therefore, I hereby consent to and authorize the performance of such procedure(s) as are necessary and desirable in the exercise of the veterinarian’s professional judgment. I also understand that I will be responsible for full payment of services at the time my pet is discharged from the hospital.

    I have read and understand this authorization and consent, and being of legal age (18), I hereby consent and authorize this hospital and its veterinarians and staff to perform the agreed to procedures.

    • I have been advised as to the nature of the procedure(s) and/or surgery and the risks involved.
    • I accept that anesthesia always involves some element of risk to my pet.
    • I understand that every precaution is practiced to ensure the safety of my pet before, during, and
      after the procedure.

     

    ESTIMATES AVAILABLE UPON REQUEST

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  • Please contact us with any questions at (540) 434-3903.

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