858-569-7777
[email protected]
Facebook
Instagram
Facebook
Instagram
Home
About
Our Team
FAQs
Reviews
Photo Gallery
Services
Resources
Blog
Online Forms
New Client Form
Dental Consent Form
Patient Drop-Off Form
Surgery Check-In Form
Surgery Consent Form
Pre-Surgical Instructions
Payment Options
Join Our Team
Online Pharmacy
Contact
Book Appointment
Select Page
Online Forms
Dental Consent Form
Our forms are available to fill out at anytime online. Fill out your dental consent form here.
Get started
Fill out your online forms here.
Dental Exam & Treatment Consent Form
Please enable JavaScript in your browser to complete this form.
Name
*
First
Last
Email
*
Pet's Name
*
Emergency Phone Number
*
A dental exam can help us understand your pet’s oral health and aspects of your pet’s overall health. However, a thorough exam of your pet’s mouth, teeth and gums cannot be accomplished without the use of anesthesia. In order to minimize the time that your pet is under anesthesia, it is important that we have clear instructions from you in advance with respect to how you would like us to treat any condition that we may discover during the dental exam.
Please Choose One
*
Proceed with any procedure you deem necessary to treat any condition you identify during the dental exam, including any treatment to minimize any pain my pet may experience in the future from on-going dental disease.
Proceed with any procedure you deem necessary to treat any condition you identify during the dental exam, but do not exceed my written estimate without contacting me first.
Do not proceed with any procedure without contacting me first.
Other
If Other, please explain:
*
I am the owner (or authorized agent of the owner) of the animal described above, and have the authority to execute this consent. I understand that some risk always exists with anesthesia, even in apparently healthy animals, including the possibility of death. I have discussed my concerns with the veterinarian and understand that it may be necessary to provide additional medical or surgical treatment to my pet in the event of unforeseen circumstances. I realize that no guarantee, legal or ethical, can be made to me regarding the outcome of any procedure performed. Subject to my directions above, I hereby authorize the use of anesthetics and other medications, as well as any such additional treatment, as deemed necessary by the veterinarian. I understand that hospital personnel will be employed in treating my pet. I have carefully read, and fully understand, this consent.
*
I have read and understand
The fees associated with these services have been explained to me, and I agree to pay such fees in full at the time my pet is released from the hospital.
*
I have read and agree
Signature
*
Clear Signature
Today's Date
*
Name
Submit
