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Canine Dental Consent Form


Canine Prophylaxis

The following procedures will be performed today:

Pre-Anesthesia Exam

Pre-Anesthetic Testing – Because of our commitment to providing you with the highest quality of veterinary care, we require pre-anesthesia testing. Each dental or anesthetic procedure has some risk involved. Advances in anesthesia have made routine procedures relatively safe, but occasional problems can occur due to pre-existing conditions not evident on physical examination.

HEALTH SCREEN II — We need a urine sample. Please collect at home or avoid letting your pet urinate on the way into the hospital.

  • PCV (detects anemia)
  • Platelet estimate (clotting ability)
  • Total Protein (assesses hydration and protein level)
  • BUN and Creatinine (kidney)
  • Urinalysis (kidneys and diabetes)
  • ALT (liver)
  • ALP (liver and adrenal glands)
  • Glucose (low or high blood sugar)
  • Sodium, Potassium, Chloride (electrolytes can be abnormal with many diseases)

IV Catheterization - for fluid therapy, IV medication or any emergency drugs if necessary

Fluid Therapy – intravenous fluids to maintain normal blood pressure, preserve hydration and ensure
adequate blood flow to vital organs

Anesthesia/Monitoring – respiration, blood oxygen level, EKG, temp, CO2 levels and blood pressure Anesthesia – pre medication, IV and gas anesthesia

Oral Exam – under anesthesia, evaluate each tooth

Full mouth radiographs – radiographs of all teeth to look for evidence of disease below the gum line Dental Prophylaxis - teeth cleaning (scaling & polishing)

Fluoride Treatment

Recovery Monitoring – including pain assessment


Total Cost: $554

Please sign consent for extractions. Only diseased or painful teeth are removed.