Dental Consent Form in Tulsa, Oklahoma - Woodland West Animal Hospital

Name*

First Last

Phone*

Would you like to receive updates via text?*

Yes
No

Address*

Street Address City State / Province / Region ZIP / Postal Code Country

Pet's Name*

I authorize the doctors and staff of Woodland West Animal Hospital to perform a dental cleaning, polishing and dental radiographs.:*

Yes, I do
No, I do not

For safety, all pets undergoing anesthesia will have a comprehensive blood profile. This includes a complete blood count (evaluating for anemia and infection), and blood chemistry analysis (evaluating organ function). This gives us a better evaluation of your pet's overall health status, before sedation. Your pet will also have an intravenous catheter placed in a shaved leg to give immediate access to a vein in the event of an emergency and to administer medication and fluids during the procedure. In order to place the catheter, it will be necessary to clip the hair on one or more of your pet's legs. All patients will receive pain medication when needed; this may or may not be included in the cost of the procedure. If you have any questions please indicate below:

Extractions will be an additional charge (range of $10-$500 total additional charges). If the doctor deems extractions are necessary:*

Call me before extractions
Perform any necessary extractions
Call me before extractions, but if you are unable to reach me, perform necessary extractions

***Possible complication with extractions are rare but include retained roots,infection, jaw fractures, gingival flap failures and oronasal fistulas*** If you have any questions please indicate below:

Other optional procedures:

Pedicure
Fecal parasite check
Ear cleaning
Vaccinations
Heartworm Test
Heartworm prevention
Flea and tick prevention
Microchip Placement

***MY PET HAS BEEN FASTING SINCE 12 A.M. MIDNIGHT***(day of surgery)Client Signature (Please Type Your Name to Sign). By clicking submit I acknowledge that my pet's procedure and its possible complications have been fully explained to me. I understand the risks associated with general anesthesia and that this may include death.*

Client signature: Type name to sign