Dental Treatment Consent

Name: Animal Hospital of Delhi Hills
Address: 1290 Ebenezer Road, Cincinnati, OH, 45233, United States
Telephone: 513-941-2551
Price range: $

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Dental Treatment Consent Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pet(s) before your visit. If this is an emergency, or if your pet needs urgent care, please call us at 513-941-2551 for a faster response.

Date *

Owner *

Email *

Patient *

I authorize the performance of an anesthetized oral health assessment and treatment procedure. This procedure includes a veterinarian's examination of my pet's teeth, gums, and other oral structures, as well as scaling and polishing their teeth. I also authorize the previously discussed procedure(s): *

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While your pet is under general anesthesia, we may discover that treatment is required, often involving the extraction of a tooth, or several teeth. These causes include, but are not limited to, broken teeth, severe gingivitis (gum disease) or gingival recession, and periodontal disease (disease in the space between the tooth and surrounding bone). There are additional fees associated with extractions, which include the extraction itself, nerve blocks, sutures, pain medications, additional general anesthesia time, and Elizabethan collars to go home. The individual extraction charges are determined by the complexity of the extraction and how many teeth need to be extracted.

Gold standard for a complete oral assessment, which is especially important prior to extractions, would include full-mouth dental radiographs (x-rays). Unfortunately, AHDH does not have this technology, but we do encourage referral to a board-certified veterinary dentist for those who are interested in pursuing this option.

If we determine that your pet requires any extractions, how should they be handled? *

Perform whatever procedures are needed. I understand that I will be responsible for the associated charges.
Please call me. I will be available at the following number: (Proceed to next question)
Do only what I have authorized. I understand that my pet will have to undergo another separate anesthetic episode to complete the dental treatment.

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Date *

Dental Treatment Consent

Dental Treatment Consent Form

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