Dental Consent Form - Patient Medication And Allergy History (Page 2 of 2) in pdf

Preoperative Blood T est Consent

Anesthetic Risks

The anesthetic risk of serious complications from routine procedures on healthy animals is less than one in 5000 in our

practice. The risk is higher in animals with health problems. The required physical exam will discover about 95% of

these problems. Preoperative procedures such as x-rays, blood tests and electrocardiograms may help detect underlying

problems that are not apparent from physical exam and history. Health problems that increase the risk are more likely in

animals over eight years of age. While helpful, all of these tests together would increase the cost of a procedure by $71.00

to $350.00. Therefore, they are usually not done unless there are known risk factors, suspicious signs or if the owner

requests them. If you wish these or other preoperative blood tests we can provide them at East Suburban Animal

Hospital, even on the same day as surgery in most cases.

Preoperative blood tests are highly recommended in animals over 8 years old.

I understand if tests are not performed, underlying disease processes may be missed.

I request preoperative blood tests at a fee of $71.00

I decline preoperative blood tests

Pain M anagement

Animals have pain with surgical procedures and we feel an obligation to provide pain relief. This will not only make the

pet more comfortable but also potentially speed recovery and decrease the risk of complications. Pain relief will be

provided the morning of the surgery before the procedure begins, during the surgery and for 3 or more days afterward

depending on the procedure and needs of the pet. If considered to be needed, a supply of pain medicine will be dispensed

or prescribed for you to give at home. The doctor will decide on a case-by-case basis which medication is best for your

pet.

The quote given with the estimate is the cost of our usual protocol but may vary as indicated.

I understand that no guarantee for success can be given and that some risks are involved in all procedures. The risks have

been explained to my satisfaction and the East Suburban Animal Hospital has my permission to perform the above

procedure as indicated.

**A specific veterinarian will perform the procedure ONLY IF REQUESTED AND INITITALED HERE:

Specific Requested Veterinarian__________________________ initials ___________

I understand that in an emergency situation, any veterinarian at the East Suburban Animal Hospital may need to take

action and give needed care and there may be additional charges.

I understand that the ultimate success of the proposed dental treatment may depend on adequate home care and follow-up

and acknowledge my responsibility in this regard, particularly for periodontal disease.

I understand E ast Suburban Animal Hospital is N OT a 24-hour facility .

Date____________ Signature______________________________________________________________________

Emergency phone number

___________________________ ask for __________________________________

Technician Initials: __________________

Dental Consent Form - Patient Medication And Allergy History Page 2