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Dental Release Form

Save time at your pet’s dental appointment by completing our online dental release form.

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Dental Release Form

To expedite your check-in process, please print the form, fill it out, and bring it with you to our clinic when you drop off your pet.

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Owner

I hereby authorize and direct the veterinarians of Pet Medical Center to perform the above procedure and additional diagnostic and/or treatment procedures as deemed advisable for my pet. The nature of the procedure(s) has/have been explained to me and no guarantee has been made as to the results or cure. I understand that there may be risks involved in some of these procedures.

I agree to pay, in full, for services rendered, including those deemed necessary for medical or surgical complications or unforeseen circumstances. Any estimates or charges for the planned procedures are only approximations, and the final bill may be greater or less than these amounts. All Services Must Be Paid For When My Pet Is Released.

We recommend that pre-anesthetic blood tests be performed prior to the administration of anesthesia. These tests can help us detect anemia, dehydration, diabetes, kidney disease, and liver disease. All these conditions can contribute to complications in anesthesia and surgery.

I understand and would like my pet to have blood work as an added measure of safety; this includes an organ profile, electrolytes and complete blood count for an additional charge of $106.00.
We recommend applying Sanos Sealant as a last step in the dental prophy. Sanos significantly reduces plaque and calculus by preventing bacteria from attaching to tooth surfaces. I understand and would like my pet to have Sanos Sealant applied as a plaque prevention system for an additional charge of $117.00.
I understand and would like my pet to have a pain injection following the dental work to maintain and ensure my pet’s comfort. We can also send home pain medication if needed. Cost is based on the animal’s weight.
I understand and would like my pet to have a DATAMARS identification microchip implanted for the additional cost of $52.25. The registration fee for each microchip is FREE.
I understand and give my consent for my pet to have extractions performed as deemed necessary
I understand and agree that I would like my pet to have an ECG performed prior to the administration of anesthesia and surgery to check for underlying heart disease for an additional charge of $43.00
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How would you like to be contacted after your pet’s surgery?