Atlanta Veterinary Dental Services

Phone: (770) 552-8777 | (678) 412-4670

900 Mansell Road, Suite 19 Roswell, GA 30076

  • Home
  • About Us
  • Contact Us
  • Home
  • About Us
  • Contact Us
  • Menu
    • Home
    • About Us
    • Contact Us

    Anesthesia Release Form

    • Our goal is to get your pet back to you as soon as possible, however, due to the unpredictability of surgery, some pets may not be able to leave until after 5pm. We ask that you wait until we call to let you know a pick-up time before coming to get your pet. Please also note that your pet’s procedure may not begin until later in the afternoon.
    • SpeciesBreedColorBirthdate
    • DENTAL TREATMENT: Please understand and be aware that a complete examination of the teeth and gums is impossible until the patient is anesthetized. The Veterinarian always performs a thorough gross examination during consultation. There is a fee for this service whether a procedure is performed or not performed/declined. We need your understanding and consent to proceed with other treatments as needed while your pet is under anesthesia. Minor extractions and other minor procedures are performed unless you specifically direct us not to do so. Major procedures require your further consent. If these procedures are necessary, your estimated charges are altered by the additional procedures. If we are unsuccessful in reaching you, necessary procedures will be performed.
    • I am the owner or agent for the above described animal and have the authority to execute this consent and the authorization of the above names surgeries and/or procedures.

      I understand that during the performance of the procedure(s) unforeseen conditions may be revealed that necessitate an extension of the foregoing procedure(s)or even different procedure(s) than those set forth previously. I understand the benefit of performing needed additional procedures now and avoiding an additional anesthetic episode. I hereby consent and authorize the performance of such procedures as necessary and desirable in the exercise of the veterinarian's professional judgement. I understand the nature of the procedure(s) as well as the risks involved and also realize that results cannot be guaranteed.

      I additionally authorize the use of the appropriate anesthesia, pathologist examination of the excised tissue, medication for post procedure pain management as deemed appropriate by the veterinarian, the administration of other medications, and I understand that hospital staff will be utilized as deemed appropriate or necessary by the veterinarian.

      Some of the above could result in additional charges above your estimate. I have read and understood this authorization and provide my consent by signing below.

    • MM slash DD slash YYYY

    Atlanta Veterinary Dental Services Copyright © 2023.
    900 Mansell Road, Suite 19 Roswell, GA 30076
    Phone : (770) 552-8777, Fax : (678) 412-4670
    Copyright © Atlanta Veterinary Dental Services All rights reserved.
    Sitemap | Accessibility

    Website by DOCTOR Multimedia

     
    Accessibility by WAH
    • About Atlanta Veterinary Dentistry
    • Accessibility
    • Anesthesia Release Form
    • Client Form
    • Client Information Form
    • Contact Us
    • Home
    • Pet Owners
      • About Us
      • Appointments
      • Links
      • New Clients
      • Our Veterinary Dental Team
      • Pre-Visit Requirements From Veterinarian
      • Veterinary Dental Services
        • Dental Radiography
        • Endodontics (Root Canal Therapy)
        • Exodontics (Extractions)
        • Oral Surgery
        • Orthodontics
        • Periodontics
        • Restorative Dentistry
    • Sitemap
    • Thank You
    • Thank You
    • Thank You!
    • Veterinarians
      • About Us
      • Gallery
      • Links
      • Our Veterinary Dental Team
      • Pre-Visit Requirements From Veterinarian
      • Referral Form
      • Veterinary Dental Services
        • Dental Radiography
        • Endodontics (Root Canal Therapy)
        • Exodontics (Extractions)
        • Oral Surgery
        • Orthodontics
        • Periodontics
        • Restorative Dentistry
    • yelp