Anesthesia/Dental Information

If your pet is having a dental surgical procedure completed, please fill out the below form and it will be sent to us for review. When you drop-off your pet for surgery the morning of their surgery, we will confirm with you the consent you have marked off on for each item below. If you would rather use a paper copy,  please use the "Download File" button at the bottom of the page to download, print, and fill out the form below and bring it with you when you visit us. 

    Anesthesia/Dental Consent Form

    General Consent
    I am the owner or agent for the owner of the above described animal and have the authority to execute this consent. I hereby give my consent and authorize the performance of the surgical procedure I am bringing my animal in for at Broadview Animal Clinic.
    I authorize the use of appropriate anesthetics and other medication, and I understand that hospital support staff will be employed as deemed necessary by the veterinarian. I have been advised as to the nature of the procedures and the risks involved. I realize that results cannot be guaranteed.
    Your pet will be undergoing general anesthesia plus a surgical procedure today. In order to recognize any underlying abnormalities your pet may have, we recommend having a pre-surgical blood profile run on your animal. This blood test will check kidney and liver enzymes. These blood tests will help us assess the health status of your pet more completely and determine if there are any additional precautions we need to take before surgery.
    Dental Teeth Extraction And Therapy Laser Consent
    During the performance of all dental procedures, unforeseen circumstances may require extractions of teeth that cannot be predicted beforehand. Additionally, there will be no communication, unless there are 6 or more extractions due to not wanting to prolong the patient being under anesthesia. By selecting the appropriate button below, you are consenting to authorize the performance of such procedures as being necessary in the exercise of the veterinarian's professional judgement without notification. If we are unable to reach you after one phone call attempt, then we will proceed as deemed necessary by the Veterinarian. If deemed beneficial by the doctor, there will be an additional charge for the application of our therapy laser to facilitate healing and decrease oral discomfort.
    ​The cost of this application is $19.50. 
    IV Catheter Placement Policy And Consent
    An IV catheter placement is Required for all surgical and dental patients regardless of age. The placement of this catheter allows the veterinarian staff to safely and quickly administer fluids before, during, and after surgical procedures.
    ​The cost of this catheter placement is $35.00.
    Pre-Surgical Blood Work Testing
    Broadview Animal Clinic requires pre-surgical blood work performed on all animals prior to being placed under anesthesia.
    Pre-Surgical blood work costs $83.50.
    MicroChip Placement
    While under anesthesia, we offer the placement of a MicroChip for your animal.
    The cost of this service is an additional $67.00.
    Histopath (Biopsy)
    If your animal is having a mass removed, we offer the option to have a Histopath (Biopsy) completed to determine what constitutes the mass. By consenting below, you are giving Broadview Animal Clinic the permission to send the removed mass to an outside laboratory for testing.
    ​The cost of this procedure is $256.00. 
    Elizabethan Collar
    If your pet requires an Elizabethan Collar (E-Collar) after their procedure, there is an additional charge for an E-Collar. By consenting or not consenting below, you are stating that you understand that if you do not purchase one at Broadview Animal Clinic, that your pet may still need the assistance of an e-collar in order for the surgical site to heal properly.
    The cost ranges for our E-Collars are between $12-$27 dependent on the size and breed of your pet. 
    Payment Of Services
    Full payment is expected at time of services.
    As the owner/agent, I assume responsibility for all charges incurred in the care of this animal. I understand that a surgery deposit may be required and that all other remaining charges are to be paid at the time of release and pick up of my pet. Should charges not be paid, Broadview Animal Clinic has the right to hold and board the animal at a cost of $32.50 per day. Should further collection be required via an attorney or collection agency, I understand and agree to pay all costs of such collection, including reasonable attorney fees. Your consent below indicates that you accept the above stated responsibility and will pay for the services rendered upon your animal upon pick-up of said animal.
    Surgical Pick-Up Policy
    Broadview Animal Clinic will call you when your pet is ready for pick-up. Please be advised that due to the number of surgeries we could have in the clinic on your pet's surgery day, there could be a short wait in the lobby as we read over surgical take-home instructions with other clients.

    Photo consent

    This authorizes the staff of Broadview Animal Clinic to take pictures of your pet while they are here with us and to post the pictures to Broadview Animal Clinic social media (Facebook and/or Instagram). 
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    Do You Have Any Additional Questions?