Dental Consent & Admitting Form

I understand it is the policy of Malibu Coast Animal Hospital that my pet be current on required vaccinations. Documentation must be provided before or at drop-off. If I am unable to provide documentation my pet will be vaccinated upon intake and I will be responsible for the associated charges.

I understand that my pet's procedure requires general anesthesia and/or sedation and that all precautions will be taken to ensure the safety of my pet. However, I am aware of the possible risks associated with anesthesia or sedations and acknowledge that I am responsible for all associated charges. I also understand and authorize the doctor to perform lifesaving efforts/procedures should complications arise.

Please do whatever is necessary to give my pet a healthy oral cavity. (May include extraction of teeth or dental radiographs.) * Costs are as follows: Extraction Grade 1 = $25 Extraction Grade 2 = $73 Extraction Grade 3 = $83. Full Mouth Dental X-rays (Cat or Small Dog) = $220 Full Mouth Dental X-rays (Medium or Large Dog) = $247.50

Please contact me at the phone number(s) listed above before performing any additional procedures. I understand that my pet will be kept under anesthesia for an additional ten minutes while the doctor attempts to contact me, and if the doctor is unable to reach me no further procedures will be performed and my pet will be woken up from anesthesia. I understand that this may result in the need for further procedures and/or treatment of my pet.

Please do not perform any additional procedures on my pet at this time.

We will perform a complete physical examination before your pet is anesthetized. Some conditions such as liver, kidney and certain blood disorders may not be detected without blood analysis. For these reasons we strongly recommend a preoperative blood screening be performed. This may help us detect an underlying problem that could lead to anesthetic complications. With our in-house blood analysis we can have these results quickly, enabling us to evaluate potential surgical risks. The cost for In-House lab work is $138. Would you like your pet to have a pre-anesthetic blood screening? Please initial your choice.

It is in the best interest of your pet that an IV catheter be placed and your pet be given intravenous fluids during the procedure. This will help maintain your pets blood pressure and allow rapid administration of drugs should an emergency situation develop. The cost for an IV catheter with fluids is $150. Would you like us to place and IV catheter? Please initial your choice below.

In order to offer your pets mouth the utmost protection, we recommend the application of Oravet Barrier Sealant at the conclusion of the dental prophy process. This sealant adheres to the tooth enamel and creates an invisible barrier that has been prooven to significantly reduce the formation of plaque and calculus. The cost for the Oravet Barrier Sealant is $35. Would you like your pet to have the sealant applied? Please initial your choice.