Dental Procedure Form

Save time at your pet’s dental appointment! Complete your required forms online before your visit.

Dental Procedure Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pet(s) before your visit.

Name *

First

Last

Email *

Phone *

Your pet is scheduled for a dental procedure today. We will do a thorough teeth cleaning and oral exam, which is included in our basic dental fee. If any further treatment is recommended, there will be additional fees not included in the basic teeth cleaning. It is safer for your pet to complete all needed dental procedures during their initial visit rather than to sedate your pet again at a later time. Please initial below on how to proceed should any abnormalities requiring additional treatment: *

Please perform the necessary procedures and extractions at this time. Additional fees will apply, this will be determined, once the procedure is started.
Please perform only the teeth cleaning and oral exam included in the basic dental cleaning fee.
Please perform the necessary procedures and extractions required at this time up to a cost of $100.00.
Please call before any additional procedures are performed.

Owner / Agent Signature *

Clear Signature

Date *

Name

Dental Procedure Form

Dental Procedure Form

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Location

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