Dental Anesthesia Consent Form Client Name First Last Patient Name First Last Phone NumberWhere you can be reached during the dayWould you like for us to text or call? Text Call Anesthetic/Surgical procedures to be performed:Pre-Anesthetic Blood Testing(Required)It is important to understand that a pre-anesthetic profile does not guarantee the absence of anesthetic complications. It may, however, greatly reduce the risk of complications as well as identify medical conditions that could require medical treatment in the future.Our greatest concern is the well-being of your pet. We will perform a physical examination before administering anesthesia. However, disorders of the liver, kidneys or blood, are not detected unless blood testing is done.Abnormalities of any of these may increase anesthetic risk. For these reasons we highly recommend pre-anesthetic blood screens. Yes, I want the pre-anesthetic blood work. I decline the recommended pre-anesthetic blood-work and understand the surgical risks. Microchip I authorize the doctor to microchip my pet while under anesthesia. Authorization to Perform Surgical Procedure and/or TreatmentsI, the undersigned owner or owner's agent, of the pet mentioned above the hereby authorize the doctors at Wake Vet Hospital & Urgent Care to perform the above anesthetic and surgical procedure(s) for my pet. I understand that some risk always exists with anesthesia and/or surgery, and that I am encouraged to discuss any concerns about those risks with the attending veterinarian before the procedure(s) is/are initiated.**I give my consent to have diseased/broken teeth extracted by the veterinarian. I understand that I will not be called before the extractions are performed.**Electronic Signature(Required) Best Contact Phone Number(Required)Date(Required) MM slash DD slash YYYY CAPTCHA Wake Veterinary Hospital & Urgent Care 1007 Tandal PlaceKnightdale, NC 27545Phone: (919) 266-9852Fax: (919) 217-0314Email: [email protected] OPEN 24 HOURS EVERY DAY For after hours emergencies, please call (919) 266-9852.