Dental Admission Form

Dental Admission Form
Owner's Name
Owner's Name

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Take home pain medication and antibiotics will be added at an additional fee if extractions are performed.

Elective Procedures to be Done at the Same Time

These are simple procedures that do not greatly increase sedation/anesthesia time and therefore can be provided at a fee less than would be required otherwise (when sedation would be required for the separate procedure) when done at the same time as the dental prophy:

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Extraction & Other Procedures Consent / Waiver

Many pets require sedation before a thorough examination can be completed. The condition of each tooth must be evaluated before a decision is made as to the best course of treatment. Although no one likes surprises, it sometimes is impossible to give an accurate estimate before sedation. From an economic standpoint, it is much more economical to complete all needed dental procedures during the initial visit and sedation rather than having to schedule another appointment with additional sedation required.

In an effort to satisfy your desires, please select the appropriate option below
Please note that if you cannot be reached, the veterinarian will proceed with needed dental procedures.

Pre-Anesthetic Screening Consent / Waiver

Like you, our greatest concern is the well-being of your pet. A physical examination will be performed before sedating your pet. However, many conditions, including disorders of the kidneys, liver, heart & blood cannot be detected without blood lab screening and heart electrocardiograms. For these reasons, we highly recommend pre-operative screening before sedating your pet.

Please choose one

Owner Release:

You are to use all reasonable precaution against injury, escape, or death of my pet. I understand that all sedation/anesthesia involves some minimal risk to my pet, but you will not be held liable in any manner whatsoever or under any circumstances in connection therewith as it is thoroughly understood that I assume all risks. I have read the foregoing and agree.