Dentistry/Anesthesia Consent Form

  • This procedure will include preparation, anesthesia, monitoring, catheterization and fluid support, and pain management. If you would like a detailed explanation of each area covered under the procedure, please see a staff member. An information form is also available for your convenience.Once your pet is under anesthesia, your veterinarian will perform a complete oral exam and carefully check your pet’s teeth and gums. During this comprehensive exam, your veterinarian may find one or more teeth that need to be extracted for health reasons. Radiographs may be required to obtain an accurate diagnosis of the condition of your pet’s teeth and jaw bone.
  • Based on the veterinarian’s recommendations, the following dental procedures and services may be required:
    • Extractions (per tooth)
    • Single root: $13.25
    • Double root: $26.00
    • Triple root: $51.50
    • Surgical extraction: $83.50 - $125.00
    • Radiographs: $58.00 (per view)
    • Extensive Dental Treatment: $91.50 (additional)

    • I have read and understand this authorization and consent and authorize the described surgical/anesthetic procedure and anesthesia for my pet.
    • I have not given my pet any food after 12 AM the morning of the procedure, unless otherwise advised by my veterinarian. I understand that this is important for anesthesia safety.
  • Date Format: MM slash DD slash YYYY

Contact Us

4122 Zulla Road
The Plains, VA 20198

Phone: 540-364-4954
Fax: 540-364-4987

Phone: 540-364-4950

Location Hours for Small Animal
Monday8:00am – 6:00pm
Tuesday8:00am – 6:00pm
Wednesday8:00am – 6:00pm
Thursday8:00am – 6:00pm
Friday8:00am – 6:00pm
Saturday8:00am – 12:30pm