Dental Consent Form


  • As the owner, or authorized agent of the above named animal, I hereby consent and authorize the clinic to receive, prescribe, treat, or operate on this animal. The nature of the procedures has been explained to me and no guarantee has been made as to the results or cure. I understand that the clinic staff & doctors will make every effort they possibly can to minimize the risk associated with general anesthesia & the services to be performed, but all risks will be assumed by me.

  • 1. Rabies - vaccination is required for pets 14 weeks and older.
    2. Fasting - I certify that the above animal has not been fed since last evening.
    3. After hours care -I understand that no one is on the premises after hours.

  • 1. Rabies - vaccination is required for pets 14 weeks and older.
    2. Fasting - I certify that the above animal has not been fed since last evening.
    3. After hours care -I understand that no one is on the premises after hours.
    4. Blood Work - Before putting your pet under anesthesia, we will perform a full physical examination. A pre-anesthetic blood profile will be performed to check the health of your pet’s organs. At risk medical conditions may not be detected without a pre-anesthetic blood profile.
    5. IV Fluids - An intravenous catheter (IV), or SQ fluid therapy will be administered for anesthesia safety. An IV gives direct access to the veins in the event of a crisis. Fluid therapy / IV will maintain normal blood pressure, providing vital movement of blood to important organs such as the heart, brain, kidneys, liver and lungs.
    6. Extractions - Depending on the condition of your pet’s teeth, extractions may be necessary. The doctor will determine if a tooth needs to be extracted. Extractions are performed at an additional cost.
    Please Note: By signing this document, I acknowledge the possibility of extractions being performed at the doctor’s discretion. Due to the nature of the procedure, we are unable to notify owners if extractions or cavity fillings are needed.
  • Pricing for extractions/cavity fill per tooth:
    Easy Extraction: $20
    Difficult Extraction: $40
    Cavity Fill:$40
  • Your pet may be sent home with a course of post-operative antibiotics. An extended-release antibiotic injection, Convenia, is available if you believe he/she would be difficult to orally medicate.
  • We highly recommend this home care after dental solution for your pet. This solution is added to your pet’s water bowl to help prolong the dental cleaning and aids in keeping breath fresh longer.
  • In the event my pet goes into cardiac/ respiratory arrest (heart stops/ stops breathing) I give permission for American Veterinary Hospital to perform CPR and other lifesaving measures. Costs of these services can run up to $250.00 and are not reflected in prior estimates.