Dental Consent Form

Please select N/A if your pet is only having one procedure performed.

General Patient Information

Please be aware: if fleas or ticks are found on your pet while in the clinic, they will be treated at an additional cost to you.

Owner Responsibility

Hospital and Procedural Information

Anesthesia: Pre-surgical blood tests and physical exam will enable us to assess and minimize the risk of anesthesia to your pet.


Monitoring: To minimize anesthesia risk, we monitor the heart, blood pressure, respiration rates, temperature, and oxygenation.


Catheterization: For sterility, hair will be shaved over a vein on the leg so that an intravenous catheter (I.V.) can be placed. Blood pressure may lower during anesthetic procedures and fluid therapy aids in supporting your pet’s internal organ systems. It also allows immediate access to the vascular system in case of an emergency.


Pain Management may be necessary for some dental procedures. The doctor will administer pain medications according to your pet’s needs, which can be an additional fee ranging from $20.00 to $50.00.


Antibiotics are an additional fee ranging from $20.00 to $75.00 and may be prescribed by Dr. Smith for your pet’s oral hygiene needs.


Pre-Op Bloodwork: Blood work is required for any patient going under anesthesia to ensure that kidney and liver function is adequate to process and eliminate anesthesia.


Please note: Additional surgical options will require an addition consent form to be signed.

Surgical Extractions

It can be difficult to predict if teeth need extraction when an animal is awake because tartar and movement interfere with the assessment. Severely diseased teeth can cause considerable pain and discomfort and are a source of infection for other organ systems (liver, kidney, lungs, and heart). During the dental cleaning, the teeth are evaluated, and if found to be diseased they may require extraction. The cost of extractions varies depending on the amount of time taken and the difficulty of the extraction and can range from $30.00 to $90 per tooth.


Once Dr. Bethany Smith has reviewed the dental radiographs and completed the oral assessment, you will be contacted at the provided number(s) regarding additional recommendations. Dr. Smith will review additional costs for recommended procedures/surgical extractions with you and request consent. If you are not reached within 15 minutes, Dr. Smith will complete the previously agreed upon care plan and begin recovery.


Please be aware that if you decline any needed procedures at this time or are not able to be reached, it may mean your pet will need second anesthesia at another time in order for those procedures to be performed.



I have read and fully understand this anesthesia and surgery consent form.

Serving the pets of Katy, TX and beyond.

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Our mission is to provide an exceptional experience through compassionate service with a personal touch. We care for your four-legged family members as our own.

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23015 FM 529 Road Suite 800

Katy, Texas 77493


Mon, Tues, Thur, Fri: 8 am - 5:30 pm

Wed: 8 am - 1 pm

Sat: 8:30 am - 12 pm

(1st and 3rd Sat of each month)

Sun: Closed

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