Dentistry Consent Form Please complete the following details. Dentistry Consent FormWhich Clinic are your visiting?(Required) Pymble Killara Patient & Customer DetailsPatient NamePatient Weight TodayCustomerAddressPhoneAlternate Contact No. if different for todayInsuranceDo you have Pet Insurance? Yes No If you wish to claim for today please let a nurse or receptionist know and we can submit it electronically for you.Would you like us to make GAP claim for you? Yes No Insurance ProviderInsurance Policy NumberQuestionsWhen was your pet last fed?Please list any medications your pet is on: Add RemoveWhen was the last dose given?Here at the Village Vet we take every surgery seriously:IV fluids: You can feel comforted knowing that all our patients are treated as required with intra-operative fluids. This allows excellent maintenance of blood pressure throughout the anaesthetic and replaces any fluid or electrolyte loss due to bleeding, sickness or dehydration. It makes every anaesthetic safer and every pets recovery more pleasant. Our patients go home far less affected by the anaesthetic drugs when they have been rehydrated peri-operatively. Pain relief: Patients require appropriate pain relief during and after surgery. Your pet will receive appropriate pain relief as part of their stay in hospital today. Your vet may send your pet home with additional medication today if necessary.Should your pet have any adverse reactions to anti-inflammatories of any kind that you know of please make us aware. Our vets highly recommend blood-testing prior to this procedure today for several reasons: To allow us to choose most appropriate fluid therapy today as indicated by the blood test. This may mean replacing electrolytes and fluids due to blood loss, dehydration or illness. We can also supplement the fluid with glucose if required. To give us an evaluation of organ function. The kidney and liver are responsible for breaking down the anaesthetic and are the first organs to be adversely affected by anaesthesia. We also run a CBC (complete blood count) which gives us valuable information about inflammation, clotting ability, anaemias and immune function. Chronic low grade anaemias are sometimes the first markers of disease and can easily go unnoticed. In addition to organ evaluation and the CBC, the calcium level can act as a marker of early cancer and other disorders. Blood test approval Yes - I am happy to proceed with the blood test at an additional $187 No - I decline the blood tests having read the above Costings and ApprovalsCost Estimate provided by vet Yes No Estimate of initial costs:If no, would you like us to provide you with one before proceeding?I am happy for the surgical nurse on duty to phone/ SMS/ email this through to me today.Since we cannot always be sure what we are going to find and how long a procedure may take we usually provide you with a high and low estimate to give you a range of best/ worst case scenario. Yes No If this dental estimate includes extractions are you happy to proceed with extractions as deemed fit by the Veterinarian as long as we keep within the estimated quote? Yes No Alternatively do you require a phone call prior to extractions? Yes No If YES, you must be contactable throughout the day as we may not be able to proceed with the appropriate procedure if you do not answer the phone when your pet is under anaestheticIf when we scale off the major calculus and tartar we find unexpected tooth decay that was not anticipated and no extractions have been estimated a Veterinarian will call to discuss the need for any extractions and any associated costs. Please be contactable throughout the day.Alternatively do you require a phone call prior to extractions? Yes- I will be contactable No- I am not contactable and realise that this is outside the scope of the estimate. I understand that if I have declined extractions and am not contactable you will not be able to complete the necessary procedures today whilst my pet is under anaesthetic. Dental radiology screening can be performed on your pets teeth . This is recommended once every 12-24mths. The cost of full mouth views is $180Would you like to proceed with this? Yes No Please note: All dental grades allow for the possibility of 1 or 2 focal dental radiographs if an unhealthy tooth is noted on examination.Any other comments or additional things you would like done today?Permission to use on social media Yes No Payment at Pickup I also agree to payment of the fees when I collect my pet from the clinic. Owners signature (or carer over 18yrs of age):Date DD slash MM slash YYYY Need help with this online form? For more information regarding orders or our services, please contact us. Call Killara: (02) 8350-5678Call Pymble: (02) 9499-4010