Dental Care and Procedure Consent Form

Our Top Priority For Your Pet's Procedure Is To Keep Them

SAFE & HAPPY

We use state-of-the-art equipment and prioritize educating our clients, so you know the appropriate aftercare for your pet.

Understanding Your Pet's Dental Procedure:

Dental procedures for animals require the use of anesthesia in order to:

• Maximize visualization of the gums, teeth, & oral cavity
• Minimize movement & discomfort
• Provide safety for your pet, our veterinarians, and hospital staff

During your pet's dental procedure, your pet will undergo a dental prophylaxis (routine teeth cleaning and polishing), during this time our veterinarians will be able to more adequately assess the condition of your pet's dental health.

Our veterinarians will exercise their medical judgment and will perform whatever services they deem medically necessary, including, but not limited to, the need for loose/damaged teeth to be extracted, to ensure the best outcome possible for your pet's dental procedure. With that being said, our veterinarians will do their best to remain within the provided procedure cost estimate ranges.

What is Pre-Anesthetic Bloodwork?

Pre-anesthetic bloodwork consists of a CBC, Chemistry, and Coag Panel. These bloodwork panels will check important values such as kidney and liver enzymes, glucose levels, blood cells, and clotting times. These blood panels help your pet's veterinarian assess the health status of your pet more completely, allowing your pet's veterinarian to take additional precautions that may be necessary to maintain the health and safety of your pet while under anesthesia.

What is Cerenia?

Cerenia is an anti-nausea medication that helps greatly on reducing post procedure nausea / vomiting. This medication is a requirement for all surgical procedures.

Why Place an IV Catheter?

An IV Catheter will allow immediate vein access if needed in case of an emergency during a procedure. An IV Catheter also allows for easier sedation protocols for patients.

What is a Pet Microchip?

It is a very small device that will aid veterinary professionals, health officials, and pet owners in identifying pets in case they are found far away from their regular surroundings. This device cannot be used to track your pet, but to identify them in the event they are lost.

Courtesy Nail Trim

Should you like your pet's nails trimmed while under anesthesia, our team would be happy to do so at no cost to you. In the event you would like to your pet's nails dremeled, the cost will be discounted to $15.

What is Laser Therapy?

Laser Therapy stimulates tissue regeneration, promotes cell growth, and decreases the amount of healing time your pet may need after their surgical procedure. The use of Laser Therapy is not recommended for all procedures and is at the discretion of your pet's veterinarian. In the event it is advised by your pet's veterinarian for laser therapy to be completed following their procedure, there will be a nominal fee added to your invoice.

Patient Medications:

In the Event of a Life-Threatening Emergency:

I understand that during my pet's procedure, unforeseen circumstances may arise. In the event any unforeseen circumstances result in life-threatening conditions for your pet, with your permission, our team can administer life-saving measures, such as: emergency drugs, oxygen therapy, and CPR.

By authorizing life-saving measures for your pet, you are hereby consenting to our veterinarians to use their professional judgment to act and/or react to these unforeseen circumstances, which may incur additional fees at your expense.

I understand that I will be financially responsible for all emergency procedure expense costs and that our staff is not required to contact you with an estimate of costs prior to administering life-saving measures if prior authorization is selected. I hereby authorize the staff of Northwood Animal Hospital "NAH" to render any treatment that is deemed necessary to the health of my pet(s) while in the custody of the hospital. I understand that in the event of any unusual or emergency circumstances, the staff will make a reasonable attempt to contact me before, if time permits, proceeding with the treatment.

ACKNOWLEDGEMENT AND SIGNATURE

I accept that all procedures will be performed to the best of the abilities of the staff at this facility. I understand that veterinary medicine is not an exact science and that no guarantees have been made regarding the outcome of my pet's procedure.

I understand that a deposit is required for this procedure and that certain Policies and Fees apply to such. In the event you do not show up for your pet's procedure as scheduled and without notice, all previously paid deposits will be taken as a "No Show Fee," and a new $100 deposit must be paid prior to rescheduling.

If you need to reschedule your pet's procedure more than 2 weeks prior to the originally scheduled date, your deposit will be rolled over to the reschedule date. If the procedure is rescheduled less than 2 weeks in advance to the originally scheduled date, an additional $50 rescheduling deposit will be required. This deposit will add onto your initial $100 deposit and will be applied towards your total at checkout on the day of your pet's procedure. If you arrive more than 15 minutes late, your pet's procedure could be rescheduled, resulting in the $50 rescheduling deposit.

I understand that full payment is expected at the time of my pet's discharge, and agree to provide payment in full via cash, personal check, credit card, Scratch Pay or Care Credit. I understand that failing to be financially responsible with my NAH account could result in my NAH account being sent to a third-party collection agency, which may affect my credit rating.

By Electronically Signing Above, You Are Agreeing to the Terms & Conditions of this Form.

Please do not submit any Protected Health Information (PHI).