Dental Procedure Authorization Form

Owner Name(Required)

MM slash DD slash YYYY

Procedure Authorization

I hereby authorize performance of the dental procedure listed above, including placement of an IV catheter and pre-anesthetic bloodwork. I understand this procedure requires to be placed under anesthesia and that all procedures involving general anesthesia carry a very small risk of complications including death.If becomes stressed during the blood draw or catheter placement, I authorize the Doctors to administer sedation to allow catheter placement and a blood draw prior to the procedure.

(If any additional procedures are needed, the veterinarian will attempt to contact you at the number you provide below.) If I cannot be reached at the number provided, I authorize the veterinarians to perform additional procedures they deem medically necessary for ’s well being. I understand added procedures will bean additional expense. I assume financial responsibility for all services rendered and agree that payment is due on the date of the procedure. Pre-anesthetic bloodwork may be run up to one week in advance of a procedure, or at the Doctors’ discretion.


Every two seconds a family pet is lost. Many are never reunited with their families because they cannot be identified. Because of these statistics, we suggest microchips whenever a pet is sedated. HomeAgainchips are known nationwide and have a 24-hour hot-line to match chip numbers with owner’s contact information. The cost of microchip implantation is $61.50
Microchip Implant

Parasite control for the protection of all our patients, any pet left for treatment will be inspected for external parasites (fleas, ticks, ear mites, etc.).

If parasites are found, we will apply the appropriate topical treatment at the single-dose price.