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Dental Consent Form

Save time at your next appointment! Please complete your required Dental Consent Form online from any device at any time before your visit.

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Dental Consent Form

Please complete this form completely and accurately so that we can get to know you and your pet(s) before your visit. If this is an emergency or your pet requires immediate attention, please call us at 817-460-4441 for a faster response.

Owner’s Name *

First

Last

Email *

Phone *

Pet’s Name *

Dog or Cat? *

Age *

Months or Years

Other procedure(s)besides a dental also needed *

Pre-anesthetic Blood Testing

Just as with humans, blood work is performed on any pet undergoing an anesthetic procedure. This blood work gives us an insight into how your pet’s kidney and liver function as well as other potential concerns such as infections or anemia. Blood work done within the last 3 months is acceptable for today’s procedure.

Veterinary Dentist Referral

During the course of a dental cleaning it is often discovered that a pet has one or several teeth that may need further treatment such as a root canal, a filling, or other periodontal procedure. For those clients interested in saving the teeth and pursuing other options we can complete the dental cleaning procedure then refer your pet to a veterinary dentist located in south Arlington for those teeth in question. If you select the option below to be referred we will provide you with the name and phone number so that you may set up an appointment with the dentist at your convenience. Please select your choice below. *

YES, I would like a referral to the veterinary dentist. Do NOT pull any teeth.
NO, I do not want a referral to the veterinary dentist. Please extract any teeth deemed necessary by the veterinarian on duty. See note below.*

*Please be aware that it is not uncommon for a pet with dental disease to need many extractions, even as many as 8-10 or more. Leaving diseased teeth in that cannot be saved are painful for your pet and continue to cause health issues. FYI: Adult dogs have 42 teeth and adult cats have 30 teeth.

Pet’s First and Last Name: *

Microchipping

Microchipping provides a safe, simple, and permanent form of pet identification designed to quickly identify lost pets and reunite them with their owners. While your pet is under anesthesia, we can implant the microchip giving you peace of mind knowing your pet has a better chance of being returned home should he/she ever get lost. Anesthesia is NOT required for microchipping. Should you decide to do this later, it can be done as a regular office visit without anesthesia.
*We take care of all the paperwork for you!*
*Please call our office for the current price of a microchip for your pet.

Would you like your pet to have a microchip implanted today ? *

Yes I want my pet to get a microchip.
No I do not want my pet to get a microchip.
My pet already has a microchip.

Please know that while we take great care in reducing the spread of infections, should your pet not be current on his/her vaccinations we will not be held responsible for any illnesses contracted related to vaccines while they are in our facility. *

I have been advised of the nature of the procedure(s) and the risks involved. I understand that complications including but not limited to infections, cardiac arrest, and death could result. I acknowledge that no guarantee has been made as to the result or care
I hereby authorize Dr. Karen Young and/or her designated associates to perform the above-mentioned procedure(s). I assume full financial responsibility for this animal and agree to pay in full at the time of release unless other financial arrangements have been made prior to this procedure.

Owner or Authorized Agent’s Signature *

Daytime Phone Number *

Today's Date *

Printed Name *

Comment

Dental Consent Form

Dental Consent Form

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