Dental Agreement Form

Pre-Surgical Exam

All of our surgical patients will receive a full physical examination. Although many advances have been made, anesthesia does still carry some risks. During the procedure your pet’s blood oxygen level, blood pressure, heart rate and rhythm, respiration and temperature will be monitored. The anesthetic drugs we use are primarily eliminated by the kidney and liver.

We require blood screening to help identify pre-existing conditions that could lead to complications with anesthesia or healing.

I permit today’s surgeon to perform the following pre-surgical blood screening:

 I, undersigned owner/agent of the below named and admitted patient, hereby authorize the attending Veterinarian(s), her/his designated associates, assistants and staff to perform diagnostic procedures as they determine necessary for the care of my pet, including but not limited to blood tests, X-rays or other procedures as needed. Further, I authorize the attending Veterinarian(s), her/his designated associates, assistants and staff to administer such treatment as deemed therapeutically necessary. I also authorize the use of anesthetic agents if needed. Should an anesthetic be necessary, I authorize the placement of an intravenous catheter (if needed) to minimize the risk of anesthesia. I grant you my consent to receive, prescribe for, treat and/or operate upon my pet. You are to use all reasonable precautions against injury, escape or death of my pet, but you will not be held liable or responsible in any manner in connection there with as it is thoroughly understood that I assume all risks.

I understand that the attending Veterinarian will make a reasonable attempt to contact me prior to above-mentioned therapeutic procedures being performed. However, failure to complete said connections shall in no way reverse this authorization for treatment. I understand that no guarantee of successful treatment is made, and hereby verify that I have read and fully understand this authorization. Further, I assume financial responsibility for all charges, and agree to pay all charges at the time of the release of my pet from hospital care.

We are a multi-vet practice, I understand my pet may be seen by more than one veterinarian. Visitation may be available during my pet’s stay and I understand that due to the nature of the hospital setting emergency conditions may alter the length of time or time(s) of day available. It is necessary that I call and confirm visitation before my arrival. Visitation is not allowed for any patient in isolation. I am welcome to call the hospital and speak to a technician during business hours regarding my pet and understand that any diagnoses can only be made by a doctor. A doctor or technician will make every attempt to update me at least once daily during my pet’s stay.

I understand there are doctor(s) or staff member(s) in the building during business hours that are assigned to my pet’s care.

After hours monitoring via remote surveillance is utilized by our on call staff. 24 hour monitoring is available at an emergency clinic in Hagerstown, Maryland. If your pet needs close monitoring, our veterinarian may recommend your pet be transferred there overnight.

It may be necessary for our doctors to contact you concerning your pet’s status at any time during their hospitalization with us. Please provide any phone numbers that we may need during your pet’s stay.