Dauphin Vet Clinic

PO Box 556
Dauphin, MB R7N 2V4

(204)638-3044

www.dauphinvetclinic.com

Dental Consent Form Form

Name (required)
First Name (required)
Last Name (required)
Patient Name (required)

Date of Dentistry booked (required)

Importance of a phone number
Pets receive less preventative dental care than people, therefore dental procedures on pets are more involved than simply cleaning a few teeth. We strive to provide the best dental care possible for your pet. We do not know what will be involved in your pet's dental work until they are under anesthesia. If we find there is more work to be done than either of us realized, we would like to call you and make decisions with you together. We NEED a phone number where we can reach you during your pet's dental procedure.
Phone number during procedure (required)

Is your pet on any medications at this time? If so, what? (required)

Does your pet have any allergies or known health problems (heart, kidney, liver?)

Are you able to brush your pets teeth daily?

IV fluids are mandatory for all patients undergoing dental care.
We strive to provide the best and safest care for your pet. We try to use the safest anaesthetic drugs available, have monitoring equipment on your pet, to make things as safe as possible
Pre-Anesthetic Blood Testing
We strive to practice quality medicine. We STRONGLY recommend that pets have their blood screened before anaesthesia, just like people do. Blood work can warn us about underlying conditions that could lead to possible complications. We look for kidney and liver problems, as well as anaemia or low platelets which affect blood clotting and signs of infection.
Please check one of the following. (required)
Comprehensive Panel $109.97 (checks liver and kidney function and more)
No, I refuse any blood testing on my pet
Dental Procedures
Dental Cleaning (required)

Yes
No


Oral surgery for extractions (required)

Yes
No
Call first


Bonded Sealant
We are now equipped to apply a bonded sealant to teeth where the dentin has been exposed or the enamel has worn away, but the pulp is still covered. There is an additional price of $40/tooth bonded
Bonded Sealant for exposed dentin (required)

Yes
No
Call first


Laser Therapy for extraction sites (Helps to decrease pain and inflammation $20) (required)

Yes
No


Be aware
In some cases, if there is a lot of infection in the mouth or oral surgery is performed, your pet will be sent home with antibiotics. If there has been any oral surgery involved, your pet will have received "freezing" to minimize the pain, but they will also be sent home with pain medication for several days following surgery.
Other procedures?

Do you give consent to take and or use pictures taken during procedure for publication? (required)

Yes
No


Please provide email or text if you would like photos sent to you during the procedure.

Consent
By clicking Submit, you are verifying that the above information is accurate to the best of your knowledge and that you consent to the treatments agreed upon. You are also agreeing to provide payment at the time of service in either the form of Cash, cheque, Debit or Credit or making arrangements through HealthSmart Financial.

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