DENTAL ANESTHESIA CONSENT FORM

  • Where you can be reached during the day
  • Anesthetic/Surgical procedures to be performed:
  • It is important to understand that a pre-anesthetic profile does not guarantee the absence of anesthetic complications. It may, however, greatly reduce the risk of complications as well as identify medical conditions that could require medical treatment in the future.

    Our greatest concern is the well-being of your pet. We will perform a physical examination before administering anesthesia. However, disorders of the liver, kidneys or blood, are not detected unless blood testing is done.

    Abnormalities of any of these may increase anesthetic risk. For these reasons we highly recommend pre-anesthetic blood screens.
  • I give my consent to have diseased/broken teeth extracted by the veterinarian. I understand that I will not be called before the extractions are performed. There are additional fees for extractions/anesthesia time.

  • Authorization to Perform Surgical Procedure and/or Treatments

    I, the undersigned owner or owner's agent, of the pet mentioned above the hereby authorize the doctors at Cornwallis Road Animal Hospital to perform the above anesthetic and surgical procedure(s) for my pet. I understand that some risk always exists with anesthesia and/or surgery, and that I am encouraged to discuss any concerns about those risks with the attending veterinarian before the procedure(s) is/are initiated.

  • Date Format: MM slash DD slash YYYY