I am the owner or the agent for the owner of the animal described above, and I have the authority to execute this consent. I hereby give the doctors of Brook-Falls Veterinary Hospital & Exotic Care Inc., and any authorized agents, staff, or representatives consent to perform the following procedures or operations: general anesthesia, IV fluids, complete oral exam, full mouth radiographs, teeth cleaning and polishing, and bonded dentin sealants for chipped crowns
If you cannot be reached, we will not proceed with the procedures and your pet will need another anesthesia to finish the necessary treatments at additional cost. We are able to provide restoratives for uncomplicated crown fractures and cavities (price varies). We will contact you if these are indicated.
We recommend SANOS dental sealant after the teeth are cleaned and polished. This seals the gumline area of the tooth helping to prevent gingivitis, calculus and bone loss at the gum line for 6 months. The cost of the sealant is $100. In 6 months, it can be applied again with your pet under a mild sedative.
This is an estimate only. If the total charges exceed the high end of the treatment plan by more than 10%, we will consult you before administering further treatment. If you have any questions, please discuss this with your veterinarian before treatment is provided. The nature of these operations or procedures has been explained to me, and I understand what will be done. I have been informed that there are certain risks and complications associated with any operation or procedure of this type, and that during the course of the procedures unforeseen conditions may arise that may necessitate the performance of additional procedures. I authorize the use of appropriate anesthesia and pain relief medication as needed before or after the procedures. I understand that hospital support personnel will be used as deemed necessary by the veterinarian.
