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20 N. Valle Verde Dr. Henderson, NV 89074(702) 434-2090
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Pre-Anesthesia Consent Form: Dental Cleaning

For dental cleanings under anesthesia. Please complete it before the day of your pet’s cleaning.

Is your pet sick or hurt right now? Please call us at (702) 434-2090 instead of filling out a form.

Fields marked Required must be filled in. Everything else is optional.

You and your pet

If you know it

For example: dog, cat, rabbit

The procedure

Describe the procedure, for example: dental cleaning, mass removal

Like you, our greatest concern is your pet’s well-being. A full physical exam is done before any anesthesia. The price of each dental includes an intravenous catheter and fluid therapy, pain medication before, during, and after the procedure, anesthesia monitoring throughout, and an application of OraVet sealant.

Your choices

Please answer each one.

Pre-anesthetic blood testingRequired

A blood analysis can reveal underlying problems that may not be outwardly visible. It shows us how your pet’s vital organs are working, which can play a critical role in deciding how much risk is involved. A doctor reviews these results before giving any anesthetic.

Dental take home kitRequired

After the teeth are cleaned, the next step is to slow the return of tartar and plaque. Pets need dental care too.

The kit includes T/D treats, given twice a day to control tartar (canine, feline, and small bites), and Aquadent, an antiseptic water additive that helps control bad breath.

Advanced diagnostics and treatmentRequired

Extractions, antibiotics, radiographs, and pain medication may be needed depending on how severe the dental disease is. I understand I am responsible for the cost of medications given in the hospital or prescribed for home.

How to reach you that day

It is very important that the doctor can reach you with questions about your pet. If we cannot reach you, treatment may be postponed.

Consent and signature

  • I certify that I am the owner, or the duly authorized agent of the owner, of the animal described above and have the authority to give this consent.
  • I understand that an unforeseen situation may arise during the procedure that requires extending or changing the procedure described above. I authorize Valley Ranch Animal Hospital to use reasonable care and judgment in performing the procedure.
  • I have been advised of the nature of the procedure and the risks of general anesthesia for the animal described above. I understand that results cannot be guaranteed.
  • I have read and understand this authorization and consent, and I accept financial responsibility for all services provided.
Agreement

Questions about this form? Call us at (702) 434-2090.

Call(702) 434-2090Request visit