Dental Release Form

Pre-anesthetic blood tests are necessary to increase the safety of your pet during anesthesia. These blood tests can help us detect anemia, dehydration, diabetes, kidney, livery, and heart disease. All of these conditions can contribute to complications in anesthesia and surgery **Pre-anesthetic blood work will be mandatory if your pet is seven years or older. **

EKG is a noninvasive procedure. Electrodes are placed on your pets skin and connected in a specific order to a machine that, when turned on, measures electrical activity all over the heart. Results are sent to a specialist to be reviewed to make sure the patient’s heart can withstand anesthesia and surgery.

Recommended by our veterinarians, Dental Radiographs are images of the interior of the teeth and gums used to identify problems, such as tooth decay, fractures, or other abnormalities.

The Veterinarian may determine that dental extractions are necessary. If so, how would you like us to proceed?

• I authorize and direct the veterinarians of Animal Care Center to perform the procedures and additional diagnostic and/or other treatment as deemed advised 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 these procedures
• I understand to prevent additional anesthetic procedures and gum disease, if noted, deciduous teeth or “baby teeth” may be extracted at an additional cost per tooth.
• I understand that pain medication will be administered & support personnel will be used accordingly if deemed unnecessary by the attending veterinarian for the stated procedure at additional costs.
• 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 will be paid for when my pet is released to me.
• I understand that a deposit may be required before surgery or procedures are performed.
• I understand that my pet’s surgical site may be shaved for the procedure.
• I understand that an I.V. catheter may be placed to have venous access during the procedure which will require the area to be shaved. I, the undersigned, certify that I am the owner, or authorized agent, of the animal listed above and I hereby consent to the described procedure and agree with all forgoing statements.