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Hours 840 E Main St
Midlothian, TX 76065

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Call: (972) 775-2901
Hours
About Us
Services
Alternative Care
Boarding
Pet Corner
Contact
Download Our App
Careers

Dental Surgery Form

Patient Name*

I, the undersigned owner, have been informed that my pet needs preventive or therapeutic dental care and hereby consent to the appropriate procedures described to me by staff veterinarians at this facility. These procedures include but are not limited to the following:

Dental prophylaxes (routine teeth cleaning and polishing)

Extractions

Oral surgery to close gaps left by extractions. I am aware that dental procedures for animals require the use of anesthesia to:

Maximize visualization of the gums, teeth, and oral cavity

Minimize movement and discomfort, and

Provide for the safety of the pet, doctors, and hospital staff. I understand that some risks always exist with anesthesia and dental procedures and that I am encouraged to discuss any concerns I have about those risks with my attending veterinarian before these procedures are initiated. I understand the doctor and staff will use all reasonable precautions against injury, escape, and/or death of my pet. I understand that all anesthetics involve some minimal risk to my pet and I will not hold the doctor or staff responsible under any circumstances. I understand I assume all risks. I have been informed that examinations under anesthesia often reveal abnormally loose teeth that fall out or should be extracted to prevent oral discomfort and ongoing infection of the surrounding bone. I also have been informed that the loss or removal of one or more unhealthy canine teeth occasionally allows for an awkward protrusion of the tongue to one side or the other. If my pet has more than _______ such teeth that should be extracted, I request that a staff member contact me for authorization or information about other options. If I cannot be reached within 10 minutes while my pet is undergoing anesthesia and dental care, no further services will be rendered at that time.
*

0 Teeth

1 Tooth

2 Teeth

3 Teeth

No Need to Call

Your pet will be undergoing general anesthesia plus a surgical procedure today. To recognize any underlying abnormalities your pet may have, we recommend having a pre-surgical blood profile run on your animal. This consists of a check of the ELECTROLYTES, CBC, which will check blood cells, and an ALT, ALKP, CREA, GLU, TP, and BUN, which will check blood glucose, kidney and liver enzymes. These blood tests will help us to assess the health status of your pet more completely and determine if there are any additional precautions we need to take before surgery.

We highly recommend a blood profile for animals over 5 years of age. There is an additional charge of $157.82 for these blood tests. We hope you understand the need for these important tests. This is a requirement if your pet is over the age of 7 years.*

Yes, please run pre-surgical labwork

No, I understand the risk of anesthesia without labwork.

No, my pet has had labwork within the last 30 days at Midlothian Veterinary Clinic.

Would you like to add: Microchip Implantation $73.01 (Includes 1st year of service)*

Yes

No

No, the pet already has a chip, please verify the number

Laser Therapy (Post-Op) $25.49*

Yes

No

Please leave any additional notes or concerns you may have for the doctor.

Midlothian Veterinary Clinic

840 E Main St Midlothian, TX 76065 email: midlothianvetclinic@yahoo.com phone: (972) 775-2901

Proudly serving Midlothian, TX and the surrounding areas.

Office Hours

Monday: 8:00 AM - 6:00 PM*

Tuesday: 8:00 AM - 6:00 PM*

Wednesday: 8:00 AM - 6:00 PM*

Thursday: 7:00 AM - 7:00 PM*

Friday: 8:00 AM - 4:00 PM*

Saturday: Closed

Sunday: Closed

*We close daily from 12:00 PM-1:00 PM for lunch

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