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Dental Treatment Consent Form

Before your pet’s dental procedure, please complete this consent form to help us ensure a safe and smooth experience.

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Dental Treatment Consent Form

Good oral health is key to your pet’s well-being—fill out this form so we can provide the best care during their dental procedure.

Vaccinations must be current to stay in the hospital. If your pet has been vaccinated elsewhere, please either bring a copy of the records (or receipt) or upload a copy to us prior to your pet's visit.

External Parasite Protection

EXTERNAL PARASITES: Pets found to have fleas or ticks upon presentation will be treated and charged accordingly ($15.00 for pets under 25#, $25.00 for pets over 25#) Pre-Anesthetic Bloodwork Pre-Surgical Lab Testing appropriate to your pet's age and health status has been performed or will be performed prior to giving any medications.

Pre-Anesthetic Bloodwork

Pre-Anesthetic Bloodwork Pre-Surgical Lab Testing appropriate to your pet's age and health status has been performed or will be performed prior to giving any medications.

Resuscitative directive

Extractions

I understand that dental extractions will NOT performed without my express permission. If extractions are determined to be needed during your pet's dental assessment, but were not anticipated and authorized by your signing an $Estimate covering the charges for extractions, Cimarron Animal Hopsital will attempt to call you to get verbal authorization for the procedure.

It is VERY important that we have a contact number where you can be reached throughout your pet's stay.

Oravet, plaque barrier sealant

Oravet can be applied after the teeth are cleaned to reduce the build-up of new plaque. This is especially helpful for small breeds and dogs prone to rapid tartar accumulation. Follow up home care, once a week, is important to continue the benefit of this treatment.

Other services

Contact information

It is CRITICAL that we have contact information so that you can be reached throughout the day in case of Emergency or the Doctor needing to discuss your pet's condition.

By Typing my Name Below*

I authorize a Dental Treatment (General anesthesia/ Dental Radiographs/ Dental Cleaning) to be performed on my pet in my absence. I further authorize any other procedures that I have indicated in this document. I have been advised as to the nature of the procedure(s) and the risks involved. I realize that results cannot be guaranteed. I agree to pay for all services rendered at the time of my pet's discharge regardless of outcome.