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Dental Consent Form

Our Dental Consent Form allows you to approve recommended dental services and helps our team plan for safe, effective care during your pet’s dental procedure. Submitting this form in advance keeps your visit organized and supports clear communication.

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How to Complete the Form

To complete the Dental Consent Form, please provide your contact information, your pet’s name, and an emergency phone number. You will then be asked to review and select your treatment preferences, read and acknowledge the anesthesia consent and payment agreement, and provide your signature and today’s date. Once all required fields are completed, submit the form at the bottom of the page.

Dental Consent Form

Please submit the Dental Consent Form before your pet’s dental appointment to help us move forward efficiently.

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

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 *

Urgent Concerns?

If your pet has urgent dental pain, facial swelling, or a sudden change in eating, please call our clinic directly.

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Dental Consent Form

How to Complete the Form

Dental Consent Form

Urgent Concerns?

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