VILLAGE VETS CENTRE LTD
65 Quarry Street Woolton Liverpool L25 6EZ
Tel: 0151 428 8600
$$Customer Name$$ $$Customer Address 1$$ $$Customer Address 2$$ $$Postcode$$
$$Telephone$$
Dog Dental Surgery Consent Form
Practice Copy
Description of Patient:
$$Animal Name$$ $$Type$$ $$Breed$$ $$Age$$ $$Sex$$ $$Weight$$
Please tick or circle:
1 I am the owner/ acting on behalf of the owner of the animal detailed above. I am
over 18 years of age. [ ]
2.I give permission for the administration of an anaesthetic, to a dental de-scale and
polish, tooth removal and to any other procedures which may prove necessary.
[ ]
3. Pre-operative blood test. Blood tests are used to screen for some diseases such
as kidney and liver disease that may increase the anaesthetic risks for your pet. They
CANNOT detect all diseases (e.g. heart problems are not identified by routine blood
screens). Having a blood test does not guarantee that there will be no problems.
[YES]/[NO]
4. Microchip. A microchip is a rice grain sized piece of glass with a unique code to
identify your pet. In the event of your pet being lost or stolen a quick scan by a vet or
rescue centre can trace them back to you. Please note: From April 2016 it is a
LEGAL REQUIREMENT for all dog owners to have their dog microchipped.
[YES]/[NO]
5. French Lungworm Treatment. This worm (Angiostrongylus vasorum) is present in
the Merseyside area and infected dogs can have problems with their blood clotting
which means that a simple operation can result in severe bleeding. This may require
a blood transfusion and can cause death of the affected animal. Blood transfusion
costs are not included in the estimate for the above procedure(s). There are two
licensed products used in the UK to treat this infection - Advocate and Milbemax.
i. My dog has been treated with Advocate or Milbemax [YES]/[NO]
ii. If YES, write how long ago the last treatment was given.
______________________________
iii. If NO, I agree to an additional in-house 'Angiodetect' blood test to see if
my pet is currently infected. This is a separate blood test to routine screens.
[YES]/[NO]
6. I understand that:
i. All anaesthetic techniques, drug treatmentsand surgical procedures involve
some risk to the animal and that all reasonable care and attention will be
Village Vets Centre Ltd 2014
Page 1
given to them. Village Vets Centre Ltd cannot be held responsible for the loss
or death of an animal through circumstances beyond their control.
ii. Many conditions, diseases and species of animal do not have officially
licenced and tested drugs available for their treatment. During the treatment
of my pet, unlicenced drugs may need to be used. Unlicenced drugs are
those which are produced for a different species of animal (e.g. dog, cat, or
human) or for a different condition to my pet. They have not undergone formal
testing and so there may be unforseen side-effects. These drugs are used
where there is no alternative or where the drug to be used is more
appropriate to the condition than a licenced drug. I consent to the use of
these drugs in the treatment of my animal, when necessary.
iii. All treatments carry risks both in the act of their administration, and in the
effects or side-effects of the drugs.
iv. There are no staff overnight at Village Vets Centre. If your pet requires
overnight hospitalisation and you desire them to be closely monitored then
they will be transferred to the night centre. Speak to a member of staff for
more details.
v. All records of investigation, treatment, radiographs, and lab reports are the
property of the practice.
vi. There is a charge for completion of insurance claims. Please ask a
member of staff.
[ ]
7. We are unable to determine if teeth need extracting until the animal is under
general anaesthetic and the teeth have been fully cleaned. In some cases we may
need to x-ray the teeth to check for damage to their roots and jaw. If we find some
teeth need to be removed we will telephone you on the above number. Please check
your contact details are correct, if we are unable to contact you WE WILL NOT
REMOVE THE TEETH. It is your responsibility to make sure you keep your contact
details up to date.
[ ]
8. Veterinary dentistry differs from human dentistry. Dogsand cats have long tooth
roots, and cats in particular have very delicate teeth. This means we have to use
different techniques to remove teeth and treat them than you may be used to in
human dentistry - often this takes longer to do and thus can cost more than your own
treatment. There is no other way to perform these procedures safely and there is no
NHS supporting the cost for animal dentistry.
[ ]
9. If during our examination under anaesthetic we see unusual lumps, injuries or
damage to your pet's mouth we may advise that samples are collected and sent to a
veterinary pathologist to try and identify what it is. There is a separate fee for doing
so. Please note: Veterinary pathologists are specialists in their area of work but it is
not possible for them to identify the cause of a problem in every case. Doing these
tests does not guarantee a diagnosis.
[ ]
10. Rarely, during our examination under anaesthetic we may discover a problem
that is so advanced it requires referral of your pet to a veterinary dental specialist
(similar to a hospital orthodontic consultant). There is a separate referral fee for this
to be done.
[ ]
POST-OPERATIVE COMPLICATIONS
A small percentage of animals may get post-operative complications, similar to a
small percentage of people who undergo surgery. The most common complications
are: a build up of fluid at the operation site, swelling, reactions to sutures or infection.
If necessary, the vet may need to prescribe antibiotics and see the animal back to
check it more frequently than for most animals. The cost of medication for these
Village Vets Centre Ltd 2014
Page 2
uncommon circumstances is not included in the price of the operation and will need
paying for at the time.
I agree to pay the value of the estimate now, and any remaining balance upon
collection of $$Animal Name$$
PRINT NAME:
DATE:
Village Vets Centre Ltd 2014
SIGN:
Page 3
VILLAGE VETS CENTRE LTD
65 Quarry Street Woolton Liverpool L25 6EZ
Tel: 0151 428 8600
$$Customer Name$$ $$Customer Address 1$$ $$Customer Address 2$$ $$Postcode$$
$$Telephone$$
Dog Dental Surgery Consent Form
Client Copy
Description of Patient:
$$Animal Name$$ $$Type$$ $$Breed$$ $$Age$$ $$Sex$$ $$Weight$$
For more information visit our website:
www.village-vets.com/cats-dogs/handy-hints-tips/
www.village-vets.com/cats-dogs/dental-hygiene/
Please tick or circle:
1 I am the owner/ acting on behalf of the owner of the animal detailed above. I am
over 18 years of age. [ ]
2.I give permission for the administration of an anaesthetic, to a dental de-scale and
polish, tooth removal and to any other procedures which may prove necessary.
[ ]
3. Pre-operative blood test. Blood tests are used to screen for some diseases such
as kidney and liver disease that may increase the anaesthetic risks for your pet. They
CANNOT detect all diseases (e.g. heart problems are not identified by routine blood
screens). Having a blood test does not guarantee that there will be no problems.
[YES]/[NO]
4. Microchip. A microchip is a rice grain sized piece of glass with a unique code to
identify your pet. In the event of your pet being lost or stolen a quick scan by a vet or
rescue centre can trace them back to you. Please note: From April 2016 it is a
LEGAL REQUIREMENT for all dog owners to have their dog microchipped.
[YES]/[NO]
5. French Lungworm Treatment. This worm (Angiostrongylus vasorum) is present in
the Merseyside area and infected dogs can have problems with their blood clotting
which means that a simple operation can result in severe bleeding. This may require
a blood transfusion and can cause death of the affected animal. Blood transfusion
costs are not included in the estimate for the above procedure(s). There are two
licensed products used in the UK to treat this infection - Advocate and Milbemax.
i. My dog has been treated with Advocate or Milbemax [YES]/[NO]
ii. If YES, write how long ago the last treatment was given.
______________________________
iii. If NO, I agree to an additional in-house 'Angiodetect' blood test to see if
my pet is currently infected. This is a separate blood test to routine screens.
[YES]/[NO]
6. I understand that:
i. All anaesthetic techniques, drug treatmentsand surgical procedures involve
some risk to the animal and that all reasonable care and attention will be
Village Vets Centre Ltd 2014
Page 4
given to them. Village Vets Centre Ltd cannot be held responsible for the loss
or death of an animal through circumstances beyond their control.
ii. Many conditions, diseases and species of animal do not have officially
licenced and tested drugs available for their treatment. During the treatment
of my pet, unlicenced drugs may need to be used. Unlicenced drugs are
those which are produced for a different species of animal (e.g. dog, cat, or
human) or for a different condition to my pet. They have not undergone formal
testing and so there may be unforseen side-effects. These drugs are used
where there is no alternative or where the drug to be used is more
appropriate to the condition than a licenced drug. I consent to the use of
these drugs in the treatment of my animal, when necessary.
iii. All treatments carry risks both in the act of their administration, and in the
effects or side-effects of the drugs.
iv. There are no staff overnight at Village Vets Centre. If your pet requires
overnight hospitalisation and you desire them to be closely monitored then
they will be transferred to the night centre. Speak to a member of staff for
more details.
v. All records of investigation, treatment, radiographs, and lab reports are the
property of the practice.
vi. There is a charge for completion of insurance claims. Please ask a
member of staff.
[ ]
7. We are unable to determine if teeth need extracting until the animal is under
general anaesthetic and the teeth have been fully cleaned. In some cases we may
need to x-ray the teeth to check for damage to their roots and jaw. If we find some
teeth need to be removed we will telephone you on the above number. Please check
your contact details are correct, if we are unable to contact you WE WILL NOT
REMOVE THE TEETH. It is your responsibility to make sure you keep your contact
details up to date.
[ ]
8. Veterinary dentistry differs from human dentistry. Dogsand cats have long tooth
roots, and cats in particular have very delicate teeth. This means we have to use
different techniques to remove teeth and treat them than you may be used to in
human dentistry - often this takes longer to do and thus can cost more than your own
treatment. There is no other way to perform these procedures safely and there is no
NHS supporting the cost for animal dentistry.
[ ]
9. If during our examination under anaesthetic we see unusual lumps, injuries or
damage to your pet's mouth we may advise that samples are collected and sent to a
veterinary pathologist to try and identify what it is. There is a separate fee for doing
so. Please note: Veterinary pathologists are specialists in their area of work but it is
not possible for them to identify the cause of a problem in every case. Doing these
tests does not guarantee a diagnosis.
[ ]
10. Rarely, during our examination under anaesthetic we may discover a problem
that is so advanced it requires referral of your pet to a veterinary dental specialist
(similar to a hospital orthodontic consultant). There is a separate referral fee for this
to be done.
[ ]
POST-OPERATIVE COMPLICATIONS
A small percentage of animals may get post-operative complications, similar to a
small percentage of people who undergo surgery. The most common complications
are: a build up of fluid at the operation site, swelling, reactions to sutures or infection.
If necessary, the vet may need to prescribe antibiotics and see the animal back to
check it more frequently than for most animals. The cost of medication for these
Village Vets Centre Ltd 2014
Page 5
uncommon circumstances is not included in the price of the operation and will need
paying for at the time.
I agree to pay the value of the estimate now, and any remaining balance upon
collection of $$Animal Name$$
PRINT NAME:
DATE:
SIGN:
VillageVets Centre Ltd , 65 Quarry Street, Woolton, Liverpool, L25 6EZ. 0151 428 8600.
POST OPERATIVE INFORMATION SHEET
$$Animal Name$$ has had an anaesthetic and is now ready to go home. Please read the
following instructions carefully :
1. $$Animal Name$$ must be kept inside for the first 24 hours.
2. $$Animal Name$$ must be kept warm and out of draughts. Do not bath them until advised
at their post-op check.
3. Feed a light meal of soft food on the day of discharge and continue this for 3 days.
4. Fresh water must be available for them at all times.
5. Medication may be given on the day of discharge (depending on the operation performed).
Please follow any instructions given and complete the course unless otherwise directed by the
vet. Please start pain relief when advised and continue AT LEAST until your pet's post-op
check when you will be advised further. Just because your pet does not appear to be in
obvious pain does not mean that they are not in discomfort.
8. $$Animal Name$$ may have stitches at their operation site. You may notice a slight watery
discharge, this can be a natural occurence. Please check the wound site daily for redness,
increased swelling, thick creamy discharge or dripping blood and contact us for advice if this
is found. If you are at all worried, however, please do not hesitate to contact the surgery. If
your pet has chewed or scratched at their stitches you MUST contact us within 24 hours.
10. Our surgery offers a free post-op check five days after an operation, please return for this
check so we can monitor recovery and advise you as necessary. If your pet has stitches
present on their skin surface they may need to return for another visit five days after their first
post-op check to have them removed - you will be advised if this is needed.
If you are at all concerned about $$Animal Name$$ or notice that they are a lot quieter
than the normal the day after surgery, please contact the practice on the above number
for advice. An emergency service is provided after normal hours.
POST OPERATION COMPLICATIONS
Village Vets Centre Ltd 2014
Page 6
After an operation in hospital, we are all told to rest and keep the operation site
clean. Pets are not aware of what has happened to them and they will try to jump and
play as normal. Some will try to chew at their wounds, especially as it begins to heal
and becomes itchy! In doing so they may present with a post-operative complication.
A surprisingly small percentage of animals will get post operation complications,
similar to a small percentage of people after surgery.
The most common complications are a build up of fluid at the operation site, swelling
or infection despite the operation being performed under sterile conditions. If
necessary, the vet may need to prescribe further antibiotics and see the animal back
to check it more frequently to make sure that the wound is healing properly. There is
no blame to be proportioned here, it is simply a well known risk when dealing with
surgical procedure. The cost of medication for these uncommon circumstances is not
included in the price of the operation and will need to be payed for at the time.
On very rare occasions, some animals will have their wound breakdown (come
open/split apart). Sometimes this is due to infection and other times this due to the
animal opening up the wound itself. These are all unfortunate events when dealing
with animals. If an animal needs a second surgery to re stitch a wound then the cost
of this needs to be met by the client, as professional time and anaesthetising costs
need to be met.
Please Note: Village Vets accepts no responsibility for complications or problems
associated with a failure to follow veterinary advice, owner or animal interference with
collars and dressings or a failure to inform us promptly of any problems.
Please note we do not have full time staff to do insurance claims as an insurance company
does. It may take up to 2 to 3 weeks before a claim can be filled in and submitted.
Village Vets Centre Ltd 2014
Page 7