Dental Care Consent Form

Dental Care Consent Form

Pet Information

All surgeries include an exam, nail trim, and ear cleaning

We do require any canine over 1 year of age have a current Heartworm Test.

All pets must be current on vaccinations.

Additional Services / Procedures

IF YOU WOULD LIKE AN ESTIMATE FOR TODAY’S SERVICES PLEASE ASK BEFORE SURGERY

*We are a flea and tick free environment. If any are noted on your pet we will treat at your expense.

Reason for Visit

Date of Surgery

Client Name - First Name

Client Name - Last Name

Phone Number

Pet Name

Age

Weight

Species

Sex

Altered

Breed

Color

We recommend bloodwork for every pet regardless of age, but do require it for any pet over 8. This bloodwork helps us detect any internal problems not evident on a physical exam.

We place an IV catheter in every surgery patient. We require it in certain patients and / or surgical procedures.

Microchip

E-Collar

Refill Preventative(s)

Anal Gland Expression

Please list any issues or concerns for today

I understand that with any sedation there are risks involved, I have been advised of these risks and wish to have my pet sedated. I also understand that any complications resulting from sedation does not relieve me from my financial obligation. (type full name as signature)

Proudly Privately Owned & Operated

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Dental Care Consent Form

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