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  • Hospital Hours:
  • Mon - Thurs: 7:30am - 7:00pm
  • Fri: 7:30am - 5:00pm
  • Sat: 7:30am - 12:00pm
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  • Phone: 262-846-6006
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  • Mon - Fri: 6:30am - 6:00pm
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Brook-Falls Veterinary Hospital & Exotic Care
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Dental Consent

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CONSENT FORM DENTISTRY SERVICES
First Client Name
  • We do not know the extent of oral disease present in your pet's mouth until a complete oral exam and full mouth radiographs have been taken under anesthesia.

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

Therefore, I give permission for oral surgery for extractions and gingival lesions/masses and pain medications if necessary up to the upper end of the treatment estimate.

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.

I wish to have SANOS dental sealant applied to my pet's teeth today.
I received a treatment plan for today's procedure within the range of

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.

Name to call with update:
To receive updates today on my pet, I prefer a:
Brook-Falls Veterinary Hospital & Exotic Care

Brook-Falls Veterinary Hospital & Exotic Care

Additional Questions
Do you wish to have your pet receive a Home Again Microchip?
Has your pet eaten anything at all in the last 12 hours?
Has your pet been given any medications, supplements, or treatments during the past 7 days?
Has your pet ever had a past anesthetic event that you thought went Poorly?
Do you have any questions for the Doctor this morning?
Do you need any medications refills today?
Do you think you will be able to brush your pet's teeth once daily long term?

Dental home care is extremely important to keep your pet's mouth clean and healthy after the dentistry today. At discharge we will discuss the recommended dental products for your pet

What products do you currently have at home and how often are they used:

How many times a week?
  •  How many times a week?
How many times a week?
How many times a week?
How many times a week?
How many times a week?
How many times a week?
Which product would you like to receive at no charge with your procedure today?

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  • N48 W14850 W. Lisbon Road
    Menomonee Falls, WI 53051
  • 262-846-6006
  • [email protected]
Brook-Falls Veterinary Hospital & Exotic Care
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