Peachtree Hills Animal Hospital Dental Surgery Consent Form

Prefix

Full Name*

First NameLast Name

Pet's name*

First NameLast Name

Phone Number*

Area CodePhone Number

E-mail*

How would you prefer to be contacted after surgery?*

PhoneText

Has the medical health of your pet changed since the surgical appointment was scheduled?

Your pet is scheduled for anesthesia and/or surgery. Our greatest concern is the well being of your pet. For this reason, prior to putting him/her under anesthesia, we will perform a complete physical examination. In addition to the physical exam, we believe every pet undergoing surgery should also have pre-anesthestic blood work, pain management, IV (intravenous) catheter and IV fluids. These procedures help reduce the risks of anesthesia and make your pet more comfortable.

Mircochip: While your pet is under anesthesia, we can place a permanent ID under your pet's skin. It is a microchip that contains a personal identification number. If your pet were to become lost and is brought to a shelter or animal care facility, they will check your pet for a microchip with a special scanner. When the ID number is picked up by the scanner they will contact the microchip company's hotline and perform a quick search through their database. Once your pet is identified, you will be contacted and reunited with your pet. The procedure is an additional cost of $64.95.

Would you like a microchip for your pet*

Yes, Please microchip my petNo, I wish to decline a microchip for my petNo, My pet already has a microchip

Hip Radiographs: These are often useful in the early diagnosis of hip disease that can lead to arthritis or hip dysplasia, and must be taken while your pet is under anesthesia. This procedure is an additional cost of $235.27

Would you like radiographs of the hips while under anesthesia?*

Yes, I would like hip radiographs for my petNo, I would like to decline hip radiographs for my pet

Dental Radiographs: We will take dental radiographs of any loose or abnormal teeth prior to extraction. This provides us with useful information about whether the tooth can be saved or whether it needs to be extracted.

If teeth need to be extracted and you want to be contacted before the extraction occurs, please leave us a contact number. If you want to be contacted and we cannot reach you, the teeth will not be extracted and additional surgery may be needed in the future.*

You have my permission to extract teeth that need to be extractedPlease call me before any extractions

Please leave a number if you want to be called before any teeth are extracted.*

Please look for a text message from us before surgery. It will provide you some information about the surgery as well as be how we will communicate with you after surgery.

Is there anything else you would like us to know?