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Online Dental Surgery Consent & Admission Form

Please complete the consent form if your pet has a dental procedure (ex: dental cleaning, tooth extraction, etc.) scheduled at Acres Animal Hospital. Note: This form should be completed after scheduling the procedure - this is not a request for an appointment. Also note: Veterinarians are not permitted to advertise prices. Please contact the clinic for an estimate.
  • Date Format: MM slash DD slash YYYY
  • Admission Information

  • Does your pet need a pet insurance claim form? Which pet insurance company?
  • Anesthesia Information

    Your pet will be given several sedative and anesthetic drugs during the course of the surgery.
  • Pre-Anesthetic Bloodwork

    Your pet is scheduled for an anesthetic procedure. To help identify problems before they occur, your pet will have blood tests before anesthesia. Dental bloodwork is included in the dental packages because dental disease increases the risk of kidney disease.
  • Basic pre-anesthetic bloodtests: Chem10 + Lyte4 blood chemistry panel + CBC (complete blood count) tests included in all dental procedures. If you would like to have additional bloodtesting performed at this time, please indicate below. If your pet is a senior, or has an existing medical condition, then additional tests to check for age related problems, or monitor progression of disease could be done now.
  • Intraoral Dental X-rays

    Intraoral (inside the mouth) dental x-rays can be done to determine the health of the teeth under the gumline and find hidden causes of disease and pain. While all dental patients will have an oral examination while under anesthesia, it is not possible to find or evaluate all types of dental problems visually or with a probe.
  • Emergency Contact

  • Consent