Dental Consent Form Name* First Last Pet's Name* I am the Owner/Authorized Agent of the above named animal, and I authorize a dental cleaning/polishing under anesthesia to be performed.Prior to any additional treatment being performed, you will be contacted by telephone when possible.The phone number(s) where you can be reached TODAY is:Phone 1Phone 2Should any unforeseeable dental procedures be deemed necessary in the veterinarian’s professional judgment: (please check one)I prefer that you proceed with all necessary dental procedures, including extraction of teeth. (I am aware that additional charges will be incurred as a result of these treatments).I prefer to be called before any additional procedures, other than emergencies. In the event I cannot be reached by phone in a timely manner, I authorize you to proceed with all necessary dental procedures. (I am aware that additional charges will be incurred as a result of these treatments).In the event I cannot be reached by phone in a timely manner, I do not authorize any additional dental procedures to be performed. (I am aware that in this case my pet may need to undergo additional future anesthesia and treatment at a later date).Additional elective procedures offered (please check services that you would like performed): Nail Trim ($10.35) Bath (ask for pricing) Ear Cleaning ($34.26-$60.13) Microchip Implantation ($53.82) Anal Gland Expression ($26.11) Laser Therapy for post-surgical pain and swelling ($20) The nature of the procedures and the potential risks, have been explained to me and I understand the procedures to be performed. I have received and reviewed a treatment plan for the expected procedures. In the even of a life-threatening emergency, I authorize the attending doctor and the team of Petsadena Animal Hospital to perform procedures deemed medically necessary. I agree that no guarantee has been stated or implied. I understand that I am assuming full financial responsibility for all services rendered at the time my pet is released from the hospital.Signature*(Your digital signature (full name) is as legally binding as a physical signature.)Date
