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Advanced Veterinary Dentistry Donald H. Deforge, VMD, LLC Fellow of the Academy of Veterinary

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Advanced Veterinary Dentistry Donald H. Deforge, VMD, LLC Fellow of the Academy of Veterinary Advanced Veterinary Dentistry www.animaldentistrysolutions.com Donald H. DeForge, VMD, LLC Fellow of the Academy of Veterinary Dentistry 17 Seemans Lane, Milford, CT 06460 P. 203-877-3221 F.203-877-8301 Email: [email protected] Welcome and thank you for choosing Advanced Veterinary Dentistry for comprehension oral testing and treatment! This booklet assists you in preparing for admissions, hospital stay, and discharge. We truly hope it, also brings to you a comfort zone of knowledge, and allows you to have a pleasant visit. Please read it carefully. It is essential information; helpful advice; and provide answers to the many questions frequently asked. Dr. DeForge and his staff are YOUR personal health care providers and caretakers of the Human-Animal Bond. We want to hear about your pet and especially want you to feel free to contact us about queries that you might have. Our team will always offer support and love to your companion and show compassion and concern in all phases of care. The information in this section is a general guide to going into hospital. Details will vary depending on why you are being admitted and which test or treatment you are receiving. You must E-Mail Dr. DeForge at [email protected] if you have any questions about this Admissions Booklet. Admission Release and Instructions If you are due to go to our hospital for elective care (pre-arranged), you will receive the Admission Release and Instructions beforehand. The Admission Release and Instructions are part of this document. Your Admission Release and Instructions will contain any special instructions you need to follow before your hospital procedure. This Admissions Booklet has an essential Adobe Sign-Electronic Signature section. You MUST complete the Adobe Sign-Electronic Signature Section within 24 hours of receiving these Internet Documents-releases. Failure to complete the Electronic Signature Adobe Sign Section [with both your Credit Card Information and Acknowledgement of Informed Consent for Treatment] after reading the entire Admission Booklet [within 24 hours of reception]…. will result in removal from Dr. DeForge’s schedule! Fill in all designated areas that may require a signature and/or additional information. Once you have completed all areas a black box will appear at the top of the document that states, I agree to the Terms and Use and Consumer Disclosure of this document “Click to Sign”. Once “Click to Sign” has been completed the document will automatically be returned to Dr. DeForge All parties that are owners of the pet must sign these documents. Only the parties who sign the Admissions Booklet can be spoken to by Dr. DeForge and/or other doctors and staff at Silver Sands Veterinary and all other consultation sites concerning the pre-care, care, and post-care of the pet mentioned in this Admissions Booklet. Consent for Treatment and/or Admission I, the undersigned owner or authorized agent of the owner seeking veterinary care for the pet identified above, certify that I am over eighteen years of age, and hereby consent to the examination of this pet by staff veterinarians at this veterinary practice. I also agree that after consultation with me, the hospital’s doctors may prescribe medication for, treat, hospitalize, sedate, anesthetize and/or perform surgery on this animal. I understand that some risks always exist with anesthesia and/or surgery and that I am encouraged to discuss any concerns I have about those risks with the attending veterinarian before the procedure is initiated. Should some unexpected life- saving emergency care be required, and the attending veterinarian be unable to reach me, this practice’s staff has my permission to provide such treatment and I agree to pay for all related fees. I understand that an estimate of the costs for veterinary services will be provided to me and that I am encouraged to discuss all fees attendant to such care before services are rendered and during this pet's ongoing medical treatment. I agree to pay a deposit of the estimated fees and assume financial responsibility for the balance of all services rendered upon discharge. I further agree that either I, or an authorized agent of mine, will pick up our pet and pay for all accrued charges when released from the hospital. Consent for Oral Care I, the undersigned owner, or owner's authorized agent, of the above pet certify that I am over eighteen years of age. I have been informed that my pet is in need of preventive or therapeutic dental care and hereby consent to the appropriate procedures described to me by staff veterinarians at this facility. These procedures include but are not limited to the following: 1) Dental Prophylaxes (routine teeth cleaning and polishing), 2) Extractions, 3) Oral Surgery 4) Root Canal/Crown procedures, 5) Periodontal HAVE YOU TALKED WITH YOUR Care, 6 )Restorative Dentistry, 7) Oral DOCTOR ABOUT THE FOLLOWING? Trauma Repair, 8) Oral Oncology, and 9) 1. The medical and/or surgical treatment A ntibiotic or Bone implants, 10) Stomatitis alternatives for your pet Surgery, 11) Pedodontics, 12) and other oral 2. Sufficient details of the procedures for procedures advised by Dr. DeForge you to understand what will be performed 3. How fully your pet might respond or I am aware that dental procedures for animals recover and how long it could take require the use of anesthesia to: 1) maximize 4. The most common complications and visualization of the gums, teeth, and oral how serious they might be cavity, 2) minimize movement and discomfort, 5. The length and type of follow-up restraint and 3) provide for the safety of the pet, and care required doctors, and hospital staff. I understand that 6. How much this treatment is expected to cost and how payment some risks always exist with anesthesia and will be handled dental procedures and that I am encouraged to discuss any concerns I have about those risks with my attending veterinarian before these procedures are initiated. Should some unexpected life-saving emergency care be required and the attending veterinarian is unable to reach me, the staff at this practice has my permission to provide such treatment and I agree to pay for such care. I accept that veterinary medicine is an inexact science and that no guarantee of successful treatment has been made. I have been informed that examinations under anesthesia often reveal abnormally loose teeth that fall out or should be extracted to prevent oral discomfort and ongoing infection of surrounding bone. I also have been informed that the loss or removal of one or more unhealthy canine teeth occasionally allows for an awkward protrusion of the tongue to one side or the other. All questions and concerns I have about the recommended dental procedures have been answered to my satisfaction. Full client education has been provided. I understand that an estimate of the fees for the above dental care will be provided to me and that I am encouraged to discuss all fees related to such care before services are rendered. I agree to pay a deposit of the estimated fees, assume financial responsibility for the balance of services rendered upon discharge, and agree to provide payment on a credit card or Care Credit, or acceptable payment plan as outlined herein. The Academy of Veterinary Dentistry is an international organization of veterinarians with a special interest in the dental care of animals. Most of the members are active practitioners, serving the oral health needs of their patients. Some work with exotic animals in the wild and at exhibition parks and zoos. Many others are involved in research, teaching, consulting and medical sales. A Fellow of the Academy of Veterinary Dentistry is a veterinarian who has had additional training in veterinary dentistry and has passed a credentialing process and examination to achieve Fellow status. Dr. DeForge is a Fellow of the Academy of Veterinary Dentistry. The Academy of Veterinary Dentistry was formed to recognize those individuals who dedicate a significant part of their professional activities to the practice of, instruction of, or research in Veterinary Dentistry. The Academy is dedicated to the continued improvement of practice standards and knowledge in Veterinary Dentistry. We further these goals by encouraging instruction and research at Veterinary Medical Educational Institutions and by sharing our knowledge and experience with practitioners through continuing education programs. Dr. DeForge is a Fellow of the Academy of Veterinary Dentistry. Examination – Consultation – Treatment – Procedure and/or Surgery Release It is your responsibility to ask and understand the answers to the below questions before admittal or before leaving if an out- patient exam. If you have questions and the doctor is not at the center at the time of admittal, DO NOT admit until you speak to the doctor. 1. The medical and/or surgical treatment alternatives for your pet? 2. Sufficient details of the procedures for you to understand what will be performed? 3. How fully your pet might respond or recover and how long it could take? 4. The length and type of follow-up restraint and care required? 5. How much this treatment is expected to cost and how payments will be handled? One of the most common complaints by clients nationally about veterinary hospitals is a lack of knowledge about services performed on the companion[s] they love. There is also dissatisfaction concerning fees for services rendered because of a lack of communication prior to admittal. Dr. DeForge and the staff of Silver Sands Veterinary Center and all Centers for Oral Care consultation sites and satellites have found the answer with DETAILED and COMPREHENSIVE Admission Packages. I authorize Dr. DeForge and whomever (s)he may designate an assistant(s), to administer such treatments, anesthesia, sedation, and/or procedure(s) as are necessary! I consent to the administration/usage of anesthesia and/or sedation in connection with the treatment(s) and/or procedure(s) by the Department of Anesthesia of all Centers for Oral Care consultation sites and satellites.
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