Dental Consent FormName* First Last Email* Phone*Secondary PhonePet Name*Pet Species*Select OneDogCatThe following are included in our STANDARD DENTAL CLEANING. Hospitalization. (CBC and Chemistry). Anesthesia (including pre-medications, induction agent, gas anesthesia, and monitoring). Intra-Oral dental radiographs. Ultrasonic enamel cleaning above and below the gum-line, rotary polish, and a pedicure.*InitialsFluid therapy: IV Catheter or subcutaneous fluids – Consent to shave for IV Fluid therapy helps to support kidney function and blood pressure during anesthesia, we include fluid administration either through an IV catheter or Subcutaneously. IV catheter placement does leave a small shaved spot.*InitialsExtent of Dental Services DesiredShould any unforeseen dental procedures be necessary and desirable in the veterinarian’s professional judgment. Please select one of the options below:* I prefer that you proceed with all necessary dental procedures. I prefer to be called before any additional procedures, other than emergencies. If I cannot be reached, I authorize you to proceed with all necessary dental procedures. If I cannot be reached by phone, I do not authorize any unforeseen dental procedures. I understand this may result in needing to reschedule additional dentistry services at a later date.Would you like your pet microchipped during their procedure(s)?* Yes No Already MicrochippedI understand I may need to reschedule additional dentistry services at a later date if the doctor decides the procedure is not able to be performed in the scheduled time.*InitialsANTIBIOTICS AND/OR PAIN RELIEF MEDICATIONS: Will only be sent home if deemed necessary by the veterinarian and price varies. Is your pet currently on any medications?* Yes NoPlease list** I understand that during the performance of the foregoing procedure(s), unforeseen conditions may be revealed that necessitate an extension of the foregoing procedure(s) or different procedure(s) than those set forth above. Therefore, I hereby consent to and authorize the performance of such procedure(s) as are necessary and desirable in the exercise of veterinarian’s professional judgement. I also authorize the use of appropriate anesthetics and other medications and I understand the hospital support personnel will be employed as deemed necessary by the veterinarian. I have been advised as to the nature of the procedures or operations and the risks involved. I realize that results cannot be guaranteed. I understand that if my pet is kenneled overnight, there are no staff members present after hours. Signature:Signature*CAPTCHAΔ