Dental Consent Form

Anesthesia can involve some unavoidable risks; we will monitor your pet closely to ensure his/her safety and

wellbeing. Our staff is well trained and we use state-of-the-art-monitoring equipment at all times. If a

problem does arise, we will institute whatever measures are needed to stabilize you pet

Dakota Pet Hospital makes great efforts to reduce postoperative complications but complications can and do

occur. I understand that I am financially responsible for any charges relating to any follow-up care, exams,

surgery, anesthesia, medications or supplies recommended by Dakota Pet Hospital to remedy any

complication.

It is very important that we have a valid phone number where you can be reached if consultation is necessary

while your pet is under anesthesia.

Additional phone numbers/contacts that are authorized to make decisions:

If I am unable to be reached, I authorize: (Please answer Yes to only one of the three following options)

I hereby authorize Dakota Pet Hospital to perform the anesthetic and surgical procedures described on my

pet. I realize that no guarantee or warranty can ethically or professionally be made regarding the results of

treatment or cure of a problem. I also authorize the clinic staff in an emergency situation, to follow through

with such procedures as are deemed necessary for the well being of my pet until further communication with

me.