Laytonsville Veterinary Practice
Laytonsville Veterinary Practice

Dental Procedure Form

Please review the form below carefully and submit this form at least 24 hours prior to your scheduled procedure.

the following form is not FOR SCHEDULING PURPOSES

Please call us at (301) 948-0158 to schedule your pet’s procedure before submitting this consent form.



Our priority is to offer necessary, life-saving and life-improving surgery at prices that are affordable and accessible for all of our clients. You may notice that some of the surgical items included on this form are optional. This is to ensure that valuable procedures do not become cost-prohibitive.

All procedures involving general anesthesia do involve an inherent risk, and in an ideal situation, all of these optional items would be selected for each and every one of our patients. However, we understand that this isn’t financially reasonable for everyone, and we are proud to offer surgery that is broadly accessible to all of our patients.

Dental procedure consent form 

Contact information
Your Name *
Your Name
Phone number where you will be reached during procedure time *
Phone number where you will be reached during procedure time
Procedure information
Procedure Date *
Procedure Date
Optional items
Some costs are kept optional to keep necessary procedures from becoming cost-prohibitive. Please read carefully and determine whether you would like the following optional items.
Pre-Anesthetic Blood Work *
In order to assess the health status and identify any pre-existing abnormalities that might affect anesthesia and surgery, we highly recommend pre-surgical blood work. The blood panel is run based on the pet’s age and health status and chosen at the doctor’s discretion. Depending on the procedure, pre-operative blood work may be recommended or required. Cost: $60 - $95
IV Catheter *
The placement of an intravenous catheter pre-operatively allows our surgical team to better manage your pet’s blood pressure and cardiac output during anesthesia which makes for a safer anesthetic experience. Depending on the procedure, IV catheter placement may be recommended or required. Cost: $88
Pain Management *
Pain management should be considered for all surgeries. The dosages and duration of medications, which may affect fees charged, will be left at the doctor’s discretion. Pain management incurs additional costs and includes both intra-operative treatments and at-home medications.
Optional dentistry items
Dental X-Rays *
Although we are able to examine the crowns of your pet's teeth during sedated dentistry, we cannot assess the health of tooth roots without the help of dental imaging. By having x-rays done at the same time as dental cleaning, we can potentially avoid missing a problem that would necessitate re-sedating the pet in a few months’ time, when the problem came to a head andcause major illness or pain. Cost: $105 (cat) $140 (dog)
Dental extractions *
Extractions of teeth, while regrettable, may be the surest way we can avoid both painful and infectious results from dental problems. Other options for diseased teeth, such as root canal therapy and bone regenerative techniques for severe periodontitis can be discussed with the doctor, and some of these procedures may require referral.
Dental Procedure Consent
Dental Procedure Consent Agreement *
By checking the box below, you consent to anesthesia and dental procedure for your pet, and understand that veterinary care during nighttime hours and/or weekends is provided at the discretion of the attending veterinarian. Continuous 24 hour presence of personnel may not be provided during these hours.