Dental Procedure Agreement Form
    Procedure Agreement
    As the owner/agent of this pet, I hereby grant my consent and authorize the veterinarian and staff at Evergreen Animal Hospital to treat, anesthetize, and/or operate upon my pet. I understand that during the performance of this procedure, unforeseen conditions may occur that require extension or variance of the planned procedure(s). I understand that the nature of the procedure(s) and risks involved; I realize the results cannot be guaranteed. I am also aware that unforeseen events resulting from the procedure(s) will not relieve me from any obligation to all costs incurred regarding the animal. Evergreen Animal Hospital will perform the procedure/surgery to the best of their ability; the hospital makes no guarantee or warranty regarding the results and I will not hold them liable.
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    Pre-Anesthetic Blood Panel 
    Anytime an animal goes under anesthetic, there is a risk for problems to arise due to pre-existing conditions not evident from a physical exam alone. To help reduce the risk of such problems, we recommend a pre-anesthetic blood panel for your pet. While this panel will not guarantee the absence of problems while under anesthetic, it may allow for the detection of factors that may lead to such problems. The pre-anesthetic blood test evaluates kidney and liver function which are essential organs in the metabolism and recovery of anesthetic. It also checks for diabetes. 
    Dental Procedure Protocol
    Your pet has been scheduled for a dental procedure to treat and prevent periodontal disease. General anesthesia is required to perform these procedures. An oral examination will occur and then we will examine your pet’s teeth and gum tissue using a dental probe to determine if any further treatment is needed, such as extractions. Extractions of diseased or damaged teeth may be necessary to prevent any further advancement of periodontal disease. Then your pet’s teeth will be scaled, polished, and rinsed. Please indicate your pet’s extraction protocol below. 
    Post-Operative Pain Management 
    Every patient receives a painkiller injection during surgery when the veterinarian deems it necessary. If you would like us to send home follow-up pain medication, please confirm that decision here. 
    Additional Services 
    Please check any of the following services you would like performed while your pet is under anesthetic. 
    We will contact you as soon as your pet’s procedure is complete. A technician will explain all pertinent information regarding the procedure at at-home care. Payment in full is required at the time of pickup.