Dental Procedure Release Form

It is our goal for each patient to have the safest, most stress-free experience possible. We follow the American Animal Hospital Association's highest surgical standards for the safety and comfort of your pet. All pets scheduled for general anesthesia receive a preoperative exam and blood panel to assess basic metabolic function, complete blood count, and liver and kidney values. This testing helps ensure there are no underlying issues with organ function, blood imbalances, or anemia that could cause complications. If any problems are found that may significantly increase the risk of anesthesia or require additional care, we will discuss them with you before proceeding.

Your pet's past anesthetic history, breed, pre-existing conditions, and age are all factors considered when creating a personalized anesthesia protocol. Cardiopulmonary (heart and respiratory) monitoring equipment is used in all extended procedures as an added precaution. IV fluids will be administered while your pet is under anesthesia to maintain proper electrolytes and hydration, which requires shaving a small section of fur from one or two legs. We use the appropriate surgical medications to keep your pet comfortable and pain-free.

There are inherent risks associated with the use of anesthesia, and Duluth Animal Hospital takes every precaution to minimize these risks. Our objective is to provide the safest and most comfortable procedure possible for your pet.

After your pet is anesthetized, a veterinary technician will clean and polish your pet’s teeth using ultrasonic and hand-scaling instruments, similar to the way a dental hygienist cleans your teeth. The veterinarian will then examine the teeth and gum tissue with a dental probe, just as a dentist examines your teeth. A set of X-rays will be taken to evaluate your pet’s teeth beneath the gum line. At this point, the doctor can fully assess your pet’s oral health and determine if any further treatment is needed, as problems are often hidden below the surface.

Additional treatments may include, but are not limited to, tooth extractions, root planing, gingival (gum) therapy, or other surgical procedures similar to those performed by an oral surgeon or periodontist. Please feel free to discuss these treatment options with the veterinarian.

I understand there are always inherent risks associated with the use of anesthesia, and that Duluth Animal Hospital takes every precaution to lessen these risks. I am encouraged to discuss any concerns I have about those risks with the attending veterinarian before the procedure(s) are initiated.

I understand that the veterinarian will make every effort to contact me regarding treatment in the case of unforeseen emergencies. If unable to contact me, the staff has my permission to proceed with life-sustaining procedures.

I understand that treatment procedures for diseased teeth are not included in the standard dental cleaning, polishing, and x-ray fees. These procedures require additional surgical time, and injections of antibiotics and pain control medications are often necessary at an additional cost.

While I accept that all procedures will be performed to the best of the abilities of the staff at this hospital, I understand that no guarantee or warranty has been made regarding the results that may be achieved.

I assume full responsibility for any additional expenses incurred after the surgical procedure is performed, such as follow-up radiographs, re-check physical exams, and additional surgery due to post-operative complications. (These are more likely to occur when aftercare instructions are not followed.)

Although every effort will be made to adhere to any estimate given, I understand that actual costs may vary according to my pet’s individual medical needs. Estimates are NOT a guarantee of final cost, and I will be responsible for any charges beyond the original estimate provided.

I understand full payment is due at the time of service by credit or debit card, CareCredit, or cash. Checks are not accepted.